Provider Demographics
NPI:1053508762
Name:BENSON, MIHAELA RUTH (MSMFT)
Entity Type:Individual
Prefix:
First Name:MIHAELA
Middle Name:RUTH
Last Name:BENSON
Suffix:
Gender:F
Credentials:MSMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ZEBRINA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5209
Mailing Address - Country:US
Mailing Address - Phone:925-309-4893
Mailing Address - Fax:
Practice Address - Street 1:39899 BALENTINE DR
Practice Address - Street 2:SUITE 310
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5355
Practice Address - Country:US
Practice Address - Phone:510-979-0200
Practice Address - Fax:510-979-0201
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43469106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist