Provider Demographics
NPI:1871075853
Name:BENKER, MIA F (LSW)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:F
Last Name:BENKER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 MADISON AVE APT 1W
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1281
Mailing Address - Country:US
Mailing Address - Phone:708-256-7659
Mailing Address - Fax:
Practice Address - Street 1:3244 MADISON AVE APT 1W
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1281
Practice Address - Country:US
Practice Address - Phone:708-256-7659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker