Healthcare Provider Details

I. General information

NPI: 1114124518
Provider Name (Legal Business Name): RACHEL LEAH BENOUN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 ESTILITA WAY UNIT B 23388 MULHOLLAND DR. MAILSTOP 84, WOODLAND HILLS, CA. 9
SIMI VALLEY CA
93063-1677
US

IV. Provider business mailing address

2919 ESTILITA WAY UNIT B
SIMI VALLEY CA
93063-1677
US

V. Phone/Fax

Practice location:
  • Phone: 805-630-3457
  • Fax:
Mailing address:
  • Phone: 805-630-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS15862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: