Provider Demographics
NPI:1437170339
Name:BENOWITZ, C. LEIGH (LICSW, BCD)
Entity Type:Individual
Prefix:
First Name:C. LEIGH
Middle Name:
Last Name:BENOWITZ
Suffix:
Gender:F
Credentials:LICSW, BCD
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:L
Other - Last Name:BENOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:146 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-1737
Mailing Address - Country:US
Mailing Address - Phone:781-641-1029
Mailing Address - Fax:781-641-1029
Practice Address - Street 1:146 RIDGE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-1737
Practice Address - Country:US
Practice Address - Phone:781-641-1029
Practice Address - Fax:781-641-1029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1069721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA372730OtherMAGELLAN PROVIDER NUMBER
000277988000OtherAETNA PROVIDER NUMBER
MAPO4434OtherBC/BS PROVIDER NUMBER