Provider Demographics
NPI:1861713380
Name:BENZA, GINO RAYMOND (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:GINO
Middle Name:RAYMOND
Last Name:BENZA
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WASHINGTON PL
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3837
Mailing Address - Country:US
Mailing Address - Phone:646-244-5785
Mailing Address - Fax:
Practice Address - Street 1:119 WASHINGTON PL
Practice Address - Street 2:SUITE C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3837
Practice Address - Country:US
Practice Address - Phone:646-244-5785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR054997-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical