Provider Demographics
NPI:1811407562
Name:BENOVIC, ELISABETH GRACE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:GRACE
Last Name:BENOVIC
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 1:2850 34TH ST N # 1140
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-3635
Mailing Address - Country:US
Mailing Address - Phone:305-934-7638
Mailing Address - Fax:
Practice Address - Street 1:2850 34TH ST N # 1140
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-3635
Practice Address - Country:US
Practice Address - Phone:305-934-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical