MEDICARE: MISS DANIELLE LEA BENTO LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC45796	CA

General Provider Information

NPI Number	:	1083807200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DANIELLE LEA BENTO LMFT

Provider Business Mailing Address
First Line	:	6711 ARLINGTON AVE
Second Line	:	STE. C
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-1955
Country	:	US
Telephone Number	:	951-352-3943
Fax Number	:	951-637-0611

Provider Business Practice Location Address
First Line	:	6711 ARLINGTON AVE
Second Line	:	STE. C
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-1955
Country	:	US
Telephone Number	:	951-352-3943
Fax Number	:	951-637-0611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	08/28/2009

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