Provider Demographics
NPI:1851939912
Name:QUINTERO, BENJAMIN G (LCDC-INTERN)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:G
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:LCDC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 SPENCER LN STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-2030
Mailing Address - Country:US
Mailing Address - Phone:210-736-4405
Mailing Address - Fax:210-736-4407
Practice Address - Street 1:571 SPENCER LN STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2030
Practice Address - Country:US
Practice Address - Phone:210-736-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46316101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)