Provider Demographics
NPI:1487830535
Name:BENES, LAWRENCE (LMHC MCAP)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:BENES
Suffix:
Gender:M
Credentials:LMHC MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 CALIQUEN DR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-5820
Mailing Address - Country:US
Mailing Address - Phone:352-650-7500
Mailing Address - Fax:352-848-3010
Practice Address - Street 1:4424 CALIQUEN DR
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-5820
Practice Address - Country:US
Practice Address - Phone:352-650-7500
Practice Address - Fax:352-848-3010
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1288OtherMASTER CERTIFIED ADDICTION PROFESSIONAL
FL681701700OtherMEDICAID WAIVER
FL019186700Medicaid