MEDICARE: MS. PATRICIA BENITEZ LCSW

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	1041C0700X	Clinical Social Worker	30114	TX

General Provider Information

NPI Number	:	1871858365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA BENITEZ LCSW

Provider Business Mailing Address
First Line	:	4205 GLEN HOLLOW CR.
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016
Country	:	US
Telephone Number	:	817-262-2631
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 GLEN HOLLOW CIR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-4914
Country	:	US
Telephone Number	:	817-262-2631
Fax Number	:

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

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/10/2012

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