Provider Demographics
NPI:1033211701
Name:BENEZRA, JULIO LEON (LPC)
Entity type:Individual
Prefix:MR
First Name:JULIO
Middle Name:LEON
Last Name:BENEZRA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 E SUMMERHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4522
Mailing Address - Country:US
Mailing Address - Phone:480-282-3807
Mailing Address - Fax:480-656-0011
Practice Address - Street 1:4425 E AGAVE RD STE 116
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-0620
Practice Address - Country:US
Practice Address - Phone:480-282-3807
Practice Address - Fax:480-656-0011
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional