Healthcare Provider Details
I. General information
NPI: 1124944673
Provider Name (Legal Business Name): BENNY JOE MAY LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1200 G ST NW STE 710
WASHINGTON DC
20005-5030
US
IV. Provider business mailing address
1360 PEABODY ST NW APT 207
WASHINGTON DC
20011-1861
US
V. Phone/Fax
- Phone: 202-998-6134
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | LG2000004838 |
| License Number State | DC |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: