Provider Demographics
NPI:1619251295
Name:BENJAMIN, MARY C (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:CORTES BENJAMIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:39W408 W BURNHAM LN
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4892
Mailing Address - Country:US
Mailing Address - Phone:630-232-2426
Mailing Address - Fax:
Practice Address - Street 1:39W408 W BURNHAM LN
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4892
Practice Address - Country:US
Practice Address - Phone:630-232-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490056581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical