MEDICARE: TERI BENSON ACSW, MSW

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	104100000X	Social Worker	ASW74370	CA

General Provider Information

NPI Number	:	1801538343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI BENSON ACSW, MSW

Provider Business Mailing Address
First Line	:	PO BOX 461647
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-9647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 S CLOVERDALE AVE APT 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4138
Country	:	US
Telephone Number	:	818-859-6004
Fax Number	:

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

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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