Provider Demographics
NPI:1689042533
Name:BENFORD, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BENFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 E CHURCHVILLE RD STE 330B
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3442
Mailing Address - Country:US
Mailing Address - Phone:410-893-4600
Mailing Address - Fax:
Practice Address - Street 1:1208 E CHURCHVILLE RD STE 330B
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3442
Practice Address - Country:US
Practice Address - Phone:410-893-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCSW-C 183491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical