Provider Demographics
NPI:1316562580
Name:BENTON, JOSEPH JAMES
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:BENTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 VALLECITO WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-9066
Mailing Address - Country:US
Mailing Address - Phone:925-775-5898
Mailing Address - Fax:
Practice Address - Street 1:2495 VALLECITO WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-9066
Practice Address - Country:US
Practice Address - Phone:925-775-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health