Provider Demographics
NPI:1659788180
Name:CUELLAR, BENJAMIN II (CALIFORNIA LCSW)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:CUELLAR
Suffix:II
Gender:M
Credentials:CALIFORNIA LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2673
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95381
Mailing Address - Country:US
Mailing Address - Phone:209-345-3543
Mailing Address - Fax:
Practice Address - Street 1:1225 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-345-3543
Practice Address - Fax:209-557-6256
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLICSW3984C1041C0700X
CALCSW766821041C0700X
CA349991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical