Provider Demographics
NPI:1942804570
Name:BENAC, SAMANTHA (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BENAC
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 S PATTERSON BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2643
Mailing Address - Country:US
Mailing Address - Phone:614-643-6846
Mailing Address - Fax:
Practice Address - Street 1:1222 S PATTERSON BLVD STE 230
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2643
Practice Address - Country:US
Practice Address - Phone:614-643-6846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2309724104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker