Provider Demographics
NPI:1407550346
Name:AGUILAR, BENJAMIN ANTHONY (LCSW)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ANTHONY
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4966 ALONZO AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3608
Mailing Address - Country:US
Mailing Address - Phone:773-410-1441
Mailing Address - Fax:
Practice Address - Street 1:4966 ALONZO AVE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3608
Practice Address - Country:US
Practice Address - Phone:773-410-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1088771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical