Healthcare Provider Details

I. General information

NPI: 1962300970
Provider Name (Legal Business Name): SQUARE ONE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2026
Last Update Date: 10/29/2026
Certification Date: 10/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11590 SEMINOLE BLVD STE C-8
LARGO FL
33778-3204
US

IV. Provider business mailing address

11590 SEMINOLE BLVD STE C-8
LARGO FL
33778-3204
US

V. Phone/Fax

Practice location:
  • Phone: 727-761-2520
  • Fax:
Mailing address:
  • Phone: 727-761-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BENINATI
Title or Position: MENTAL HEALTH THERAPIST
Credential:
Phone: 586-596-0096