Provider Demographics
NPI:1871519827
Name:BENOIT, DAVID ANTHONY (MFT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:BENOIT
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 HEMP CT
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-1537
Mailing Address - Country:US
Mailing Address - Phone:707-480-8842
Mailing Address - Fax:888-410-5491
Practice Address - Street 1:95 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6630
Practice Address - Country:US
Practice Address - Phone:707-480-8842
Practice Address - Fax:888-410-5491
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist