Provider Demographics
NPI:1023746971
Name:BENALCAZAR, MARY ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:BENALCAZAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY ELLEN
Other - Middle Name:
Other - Last Name:KANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:65 PROSPECT ST APT 6E
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-1618
Mailing Address - Country:US
Mailing Address - Phone:610-639-0647
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY PL
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2315
Practice Address - Country:US
Practice Address - Phone:203-998-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0124401041C0700X
PACW0227301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical