Provider Demographics
NPI:1184067266
Name:BENAVIDEZ, EUNICE (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:
Last Name:BENAVIDEZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 COLRAIN ST SW STE 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-1013
Mailing Address - Country:US
Mailing Address - Phone:616-988-1479
Mailing Address - Fax:616-988-1493
Practice Address - Street 1:255 COLRAIN ST SW STE 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-1013
Practice Address - Country:US
Practice Address - Phone:616-988-1479
Practice Address - Fax:616-988-1493
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094520104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker