Healthcare Provider Details

I. General information

NPI: 1710842190
Provider Name (Legal Business Name): DIAMOND BENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 RESEARCH BLVD STE 100
ROCKVILLE MD
20850-6130
US

IV. Provider business mailing address

5 RIDGE SQ NW APT 615
WASHINGTON DC
20016-2976
US

V. Phone/Fax

Practice location:
  • Phone: 240-552-5808
  • Fax:
Mailing address:
  • Phone: 410-707-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34073
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: