Provider Demographics
NPI:1639358039
Name:BENTON, JOHN D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:BENTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 BALDWIN DR
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1720
Mailing Address - Country:US
Mailing Address - Phone:779-537-4631
Mailing Address - Fax:
Practice Address - Street 1:9308 BALDWIN DR
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1720
Practice Address - Country:US
Practice Address - Phone:779-537-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0126051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical