Individual
ISMERAI BENITEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CG60662276
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CG60662276
WA
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CG60662276
—
WA
Enumeration date
07/20/2016
Last updated
01/28/2019
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