Healthcare Provider Details

I. General information

NPI: 1346349032
Provider Name (Legal Business Name): BENITA LEDER SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 QUAIL CT. SUITE 200
WALNUT CREEK CA
94596
US

IV. Provider business mailing address

33 QUAIL CT. SUITE 200
WALNUT CREEK CA
94596
US

V. Phone/Fax

Practice location:
  • Phone: 510-525-0274
  • Fax: 510-525-0274
Mailing address:
  • Phone: 510-525-0274
  • Fax: 510-525-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS4572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: