Healthcare Provider Details

I. General information

NPI: 1417566019
Provider Name (Legal Business Name): STEVEN BENGE LMSW-P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 11/27/2023
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 2ND ST NW
ALBUQUERQUE NM
87102-2218
US

IV. Provider business mailing address

1120 2ND ST NW
ALBUQUERQUE NM
87102-2218
US

V. Phone/Fax

Practice location:
  • Phone: 505-313-9257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-11545
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: