Provider Demographics
NPI:1437345683
Name:BENTON, DANA LEIGH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:LEIGH
Last Name:BENTON
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 1:226 GALLATIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-2633
Mailing Address - Country:US
Mailing Address - Phone:401-529-1783
Mailing Address - Fax:
Practice Address - Street 1:1471 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3849
Practice Address - Country:US
Practice Address - Phone:401-490-7320
Practice Address - Fax:401-490-7694
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW013181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical