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General NPI Number Information
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NPI Number | 1295202943
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Entity Type | Organization
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Legal Business Name | ANTHONY BENIGNO, PSYD., PSYCHOLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 16465 SIERRA LAKES PKWY STE 140
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City | FONTANA
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State | CA
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Zip | 92336-1242
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Country | US
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Telephone | 909-244-9593
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Fax |
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Provider Business Mailing Address
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Address Line | 16465 SIERRA LAKES PKWY STE 140
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City | FONTANA
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State | CA
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Zip | 92336-1242
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Country | US
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Telephone | 909-244-9593
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Fax | 833-903-0337
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | JOELLA WILLIAMS
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Credential |
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Telephone | 818-433-5045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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