MEDICARE: DONNA GAIL BENJAMIN M.A., MFT

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	MFC 49047	CA

General Provider Information

NPI Number	:	1992075899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA GAIL BENJAMIN M.A., MFT

Provider Business Mailing Address
First Line	:	8160 MANITOBA ST
Second Line	:	UNIT 318
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-8638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5731 W SLAUSON AVE
Second Line	:	SUITE 175
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6537
Country	:	US
Telephone Number	:	310-906-7856
Fax Number	:

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

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	09/11/2012

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