Provider Demographics
NPI:1336175538
Name:BENIEK, EUGENE JOSEPH (MA MDIV LICSW LMFT)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:JOSEPH
Last Name:BENIEK
Suffix:
Gender:M
Credentials:MA MDIV LICSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32104 STEARNS COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-267-0531
Mailing Address - Fax:320-393-2960
Practice Address - Street 1:32104 STEARNS COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-267-0531
Practice Address - Fax:320-393-2960
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6636104100000X, 1041C0700X
MN0039106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
110584C851OtherUCARE BHP
16934OtherUBH OPTUM
HP25383OtherHEALTH PARTNERS
MN500857300Medicaid
922241022554OtherPREFERRED ONE
3H565BEOtherBCBS
MN4G307BEOtherBCBS
6212386OtherMEDICA