MEDICARE: ROBERT BENEDICT L.C.S.W.

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	4864-C	NV

General Provider Information

NPI Number	:	1932142320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BENEDICT L.C.S.W.

Provider Business Mailing Address
First Line	:	2420 OCEAN FRONT DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7483
Country	:	US
Telephone Number	:	702-683-6138
Fax Number	:	703-380-3220

Provider Business Practice Location Address
First Line	:	5440 W SAHARA AVE STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0361
Country	:	US
Telephone Number	:	702-380-8200
Fax Number	:	702-380-3220

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/01/2011

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