Provider Demographics
NPI:1174872410
Name:BENAVIDEZ, OSCAR THOMAS (LMSW, CLVT)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:THOMAS
Last Name:BENAVIDEZ
Suffix:
Gender:M
Credentials:LMSW, CLVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 VETERANS DRIVE
Mailing Address - Street 2:2C-134
Mailing Address - City:HARLLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-291-9235
Mailing Address - Fax:956-291-9214
Practice Address - Street 1:2601 VETERANS DRIVE
Practice Address - Street 2:2C-134
Practice Address - City:HARLLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-291-9235
Practice Address - Fax:956-291-9214
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52292104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker