Provider Demographics
NPI:1346349032
Name:SMITH, BENITA LEDER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BENITA
Middle Name:LEDER
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 QUAIL CT.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596
Mailing Address - Country:US
Mailing Address - Phone:510-525-0274
Mailing Address - Fax:510-525-0274
Practice Address - Street 1:33 QUAIL CT.
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:510-525-0274
Practice Address - Fax:510-525-0274
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS45721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17196ZMedicare ID - Type Unspecified
32479Medicare UPIN