Provider Demographics
NPI:1558929216
Name:BENAVIDES, CINDY DARLENE (MS)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:DARLENE
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2232
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91788-2232
Mailing Address - Country:US
Mailing Address - Phone:909-594-2762
Mailing Address - Fax:909-594-2922
Practice Address - Street 1:4340 WILSON ST
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3233
Practice Address - Country:US
Practice Address - Phone:909-590-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT86097106H00000X
CALMFT125926106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist