Provider Demographics
NPI:1851462113
Name:LESSER BENTON, JONI EILEEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JONI
Middle Name:EILEEN
Last Name:LESSER BENTON
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 1:285 SOUTH ST STE J
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5037
Mailing Address - Country:US
Mailing Address - Phone:805-782-8608
Mailing Address - Fax:
Practice Address - Street 1:285 SOUTH ST STE J
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5037
Practice Address - Country:US
Practice Address - Phone:805-782-8608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 33901041C0700X
CA162401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1851462113Medicare ID - Type Unspecified