Provider Demographics
NPI:1972682896
Name:BENOY THOMAS, TABITHA RENEE (MSW)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:RENEE
Last Name:BENOY THOMAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:RENEE
Other - Last Name:BENOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:529 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013
Mailing Address - Country:US
Mailing Address - Phone:213-430-6808
Mailing Address - Fax:
Practice Address - Street 1:529 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013
Practice Address - Country:US
Practice Address - Phone:213-430-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 203881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical