Provider Demographics
NPI:1386855211
Name:YOUNG, BENITA ROSALYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BENITA
Middle Name:ROSALYN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13949 VENTURA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3584
Mailing Address - Country:US
Mailing Address - Phone:818-999-7719
Mailing Address - Fax:818-990-1702
Practice Address - Street 1:13949 VENTURA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3584
Practice Address - Country:US
Practice Address - Phone:818-999-7719
Practice Address - Fax:818-990-1702
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36983106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist