MEDICARE: ELI TROI BENWAY

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	LCSW82225	CA

General Provider Information

NPI Number	:	1760709943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELI TROI BENWAY

Provider Business Mailing Address
First Line	:	730 POLK ST FL 4
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-7813
Country	:	US
Telephone Number	:	415-696-0229
Fax Number	:	415-292-3405

Provider Business Practice Location Address
First Line	:	730 POLK ST FL 4
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-7813
Country	:	US
Telephone Number	:	415-696-0229
Fax Number	:	415-292-3405

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

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	07/10/2024

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Directions to “ ELI TROI BENWAY ” Practice Location

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