Provider Demographics
NPI:1770855744
Name:BENITEZ, LILLIAN C
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:C
Last Name:BENITEZ
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 1:769 W BLAINE ST
Mailing Address - Street 2:SUITE B.
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3970
Mailing Address - Country:US
Mailing Address - Phone:951-358-4705
Mailing Address - Fax:951-358-4719
Practice Address - Street 1:769 W BLAINE ST
Practice Address - Street 2:SUITE B.
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-358-4705
Practice Address - Fax:951-358-4719
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
101YM0800XOtherCOUNSELOR-MENTAL HEALTH