1376643494 NPI number — LYNETTE MARIE WEISS-BENOIT LCSW

Table of content: LYNETTE MARIE WEISS-BENOIT LCSW (NPI 1376643494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376643494 NPI number — LYNETTE MARIE WEISS-BENOIT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS-BENOIT
Provider First Name:
LYNETTE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376643494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1088
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEVADA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95959-1088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-798-1076
Provider Business Mailing Address Fax Number:
530-478-9589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEVADA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95959-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-798-1076
Provider Business Practice Location Address Fax Number:
530-205-9459
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  24528 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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