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Individual

BENJAMIN JOSEPH DE JESUS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
2120 S MCCLINTOCK DR STE 105, TEMPE, AZ 85282-2692
(480) 804-0326
Mailing address
1166 E WARNER RD STE 101T, GILBERT, AZ 85296-3065
(480) 375-1317

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW 16081
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
171168
AZ
Enumeration date
02/20/2014
Last updated
10/22/2018
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