Provider Demographics
NPI:1679803548
Name:BENEVIDES, ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:BENEVIDES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 WHALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1144
Mailing Address - Country:US
Mailing Address - Phone:203-389-5599
Mailing Address - Fax:203-389-5904
Practice Address - Street 1:1440 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1144
Practice Address - Country:US
Practice Address - Phone:203-389-5599
Practice Address - Fax:203-389-5904
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003973101YM0800X, 101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040572Medicaid
CTANC1295OtherOXFORD
CTCTGA000481OtherABH
CT004040572Medicaid