Healthcare Provider Details

I. General information

NPI: 1952102279
Provider Name (Legal Business Name): BEVERLY BENOIT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 CHOCTAW ST
ANDERSON SC
29626-4028
US

IV. Provider business mailing address

611 CHOCTAW ST
ANDERSON SC
29626-4028
US

V. Phone/Fax

Practice location:
  • Phone: 864-337-2043
  • Fax:
Mailing address:
  • Phone: 864-337-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2120734
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC25262
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: