Provider Demographics
NPI:1407279219
Name:BENITEZ, JANI (LICSW)
Entity Type:Individual
Prefix:
First Name:JANI
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 ECCLESTON ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4829
Mailing Address - Country:US
Mailing Address - Phone:240-502-4055
Mailing Address - Fax:
Practice Address - Street 1:2603 ECCLESTON ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4829
Practice Address - Country:US
Practice Address - Phone:240-502-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500797831041C0700X
CA1163371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical