Provider Demographics
NPI:1700028776
Name:BENKENDORF, ANDREW J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:BENKENDORF
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 1:9911 W PICO BLVD
Mailing Address - Street 2:SUITE 1480
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2703
Mailing Address - Country:US
Mailing Address - Phone:310-591-9581
Mailing Address - Fax:310-556-0455
Practice Address - Street 1:9911 W PICO BLVD
Practice Address - Street 2:SUITE 1050
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2703
Practice Address - Country:US
Practice Address - Phone:310-591-9581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 254341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical