Provider Demographics
NPI:1801580675
Name:BENSON, BETHSHELA GOE
Entity type:Individual
Prefix:
First Name:BETHSHELA
Middle Name:GOE
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 F ST NE
Mailing Address - Street 2:SUIT 102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 F ST NE
Practice Address - Street 2:SUIT 102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4917
Practice Address - Country:US
Practice Address - Phone:202-486-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200002437104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker