Provider Demographics
NPI:1205676988
Name:BENITEZ AVALOS, MINERVA CLARISSA (LMSW)
Entity type:Individual
Prefix:
First Name:MINERVA
Middle Name:CLARISSA
Last Name:BENITEZ AVALOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MINERVA
Other - Middle Name:CLARISSA
Other - Last Name:BENITEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:574 SONORA PASS CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-1814
Mailing Address - Country:US
Mailing Address - Phone:775-412-1743
Mailing Address - Fax:
Practice Address - Street 1:201 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2067
Practice Address - Country:US
Practice Address - Phone:775-298-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11524-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker