Individual
GINA BENETICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20402 N 15TH AVE, PHOENIX, AZ 85027-3699
(623) 445-5000
Mailing address
20402 N 15TH AVE, PHOENIX, AZ 85027-3636
(623) 445-5000
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BEH-000235
AZ
1041C0700X
Clinical Social Worker
LCSW-21949
AZ
Other
Enumeration date
02/23/2022
Last updated
03/11/2026
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