Healthcare Provider Details

I. General information

NPI: 1952745267
Provider Name (Legal Business Name): SHAHARAZAD BENEJAM LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 ORLANDO CENTRAL PKWY STE 480
ORLANDO FL
32809-5785
US

IV. Provider business mailing address

1315 CLOVE DR
KISSIMMEE FL
34759-5407
US

V. Phone/Fax

Practice location:
  • Phone: 407-382-9079
  • Fax:
Mailing address:
  • Phone: 863-242-4067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17465
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: