Basic Information
| Provider Information | |||||||||
| NPI: | 1528534856 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONIZE | ||||||||
| FirstName: | BENITA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4260 SASHA TRL | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347728869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9415869688 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6149 CHANCELLOR DR STE 2780 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328095633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073522542 | ||||||||
| FaxNumber: | 4073522547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2018 | ||||||||
| LastUpdateDate: | 10/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW15385 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.