Provider Demographics
NPI:1457928939
Name:BENAVENTE, JOEL CHRISTOPHER LIZAMA (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:JOEL CHRISTOPHER
Middle Name:LIZAMA
Last Name:BENAVENTE
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MARINA GATEWAY DR UNIT 1432
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-2339
Mailing Address - Country:US
Mailing Address - Phone:702-300-7582
Mailing Address - Fax:
Practice Address - Street 1:180 COUNTRY ESTATES CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4013
Practice Address - Country:US
Practice Address - Phone:775-870-5027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9347-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical