Provider Demographics
NPI:1710513486
Name:BENITONE, SARAH (LCPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BENITONE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 ENTERPRISE WAY STE 50A
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4410
Mailing Address - Country:US
Mailing Address - Phone:618-595-0305
Mailing Address - Fax:
Practice Address - Street 1:5208 MEADOWLAND PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-6386
Practice Address - Country:US
Practice Address - Phone:618-595-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014788101YP2500X
IL180.014545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional