Provider Demographics
NPI:1134674054
Name:BENSON, JADE D (MFT)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:D
Last Name:BENSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 GOLDEN RAIN RD
Mailing Address - Street 2:#2
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1947
Mailing Address - Country:US
Mailing Address - Phone:510-502-3839
Mailing Address - Fax:510-903-4212
Practice Address - Street 1:2711 ALCATRAZ AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2726
Practice Address - Country:US
Practice Address - Phone:510-502-3839
Practice Address - Fax:510-903-4212
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19990106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist