Provider Demographics
NPI:1932142320
Name:BENEDICT, ROBERT (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 OCEAN FRONT DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7483
Mailing Address - Country:US
Mailing Address - Phone:702-683-6138
Mailing Address - Fax:703-380-3220
Practice Address - Street 1:5440 W SAHARA AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0361
Practice Address - Country:US
Practice Address - Phone:702-380-8200
Practice Address - Fax:702-380-3220
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4864-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV102183Medicare PIN