Provider Demographics
NPI:1861766446
Name:BENOIT, MATTHEW IRA I (CIT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:IRA
Last Name:BENOIT
Suffix:I
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POYDRAS ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-4740
Mailing Address - Country:US
Mailing Address - Phone:337-231-6365
Mailing Address - Fax:337-231-6372
Practice Address - Street 1:100 POYDRAS ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-4740
Practice Address - Country:US
Practice Address - Phone:337-231-6365
Practice Address - Fax:337-231-6372
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3085101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)