Provider Demographics
NPI:1669777819
Name:BENON, JEFFREY SAM (CATC 102373)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SAM
Last Name:BENON
Suffix:
Gender:M
Credentials:CATC 102373
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:SAM
Other - Last Name:BENON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAC1 CA-79834
Mailing Address - Street 1:26861 TRABUCO RD
Mailing Address - Street 2:SUITE E-203
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3537
Mailing Address - Country:US
Mailing Address - Phone:949-230-2747
Mailing Address - Fax:949-680-2906
Practice Address - Street 1:26861 TRABUCO RD
Practice Address - Street 2:SUITE E-203
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3537
Practice Address - Country:US
Practice Address - Phone:949-230-2747
Practice Address - Fax:949-680-2906
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACATC 102373101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)