Basic Information
| Provider Information | |||||||||
| NPI: | 1467006379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENITEZ | ||||||||
| FirstName: | YESENIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3133 N MILLBROOK AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937031425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596009180 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3133 N MILLBROOK AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937031425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596009088 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2019 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 05/05/2021 | ||||||||
| NPIReactivationDate: | 06/25/2021 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | AMFT133778 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.