Provider Demographics
NPI:1821053414
Name:BENWARD, JEAN MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:BENWARD
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 1:18 CROW CANYON CT
Mailing Address - Street 2:STE 305
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1922
Mailing Address - Country:US
Mailing Address - Phone:925-820-9023
Mailing Address - Fax:510-538-5410
Practice Address - Street 1:18 CROW CANYON CT
Practice Address - Street 2:STE 305
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1922
Practice Address - Country:US
Practice Address - Phone:925-820-9023
Practice Address - Fax:510-538-5410
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical