Provider Demographics
NPI:1609651264
Name:BENITEZ, LESLY I (LMSW)
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:I
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 AURORA AVE STE 103E
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-6338
Mailing Address - Country:US
Mailing Address - Phone:515-401-5237
Mailing Address - Fax:515-401-5237
Practice Address - Street 1:6200 AURORA AVE STE 103E
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-6338
Practice Address - Country:US
Practice Address - Phone:515-401-5237
Practice Address - Fax:515-401-5237
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist