Healthcare Provider Details

I. General information

NPI: 1821714858
Provider Name (Legal Business Name): DESIREE BENE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 CHAPEL AVE W
CHERRY HILL NJ
08002-2048
US

IV. Provider business mailing address

2201 CHAPEL AVE W
CHERRY HILL NJ
08002-2048
US

V. Phone/Fax

Practice location:
  • Phone: 856-488-6792
  • Fax: 856-488-6454
Mailing address:
  • Phone: 856-488-6792
  • Fax: 856-488-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06849700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: