Active NPI
Gina Benetich
- Behavior Analyst
- Phoenix, AZ
National Provider Identifier
1417603010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- BEH-000235
- Practice address
- 20402 N 15TH Ave
Phoenix, AZ 85027-3699 - Phone
- (623) 445-5000
- NPI assigned
- Feb 23, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | BEH-000235 | AZ | Primary |
| Clinical Social Worker | 1041C0700X | LCSW-21949 | AZ |
Addresses
Primary practice location
20402 N 15TH Ave
Phoenix, AZ 85027-3699
Mailing address
20402 N 15TH Ave
Phoenix, AZ 85027-3636
Phone (623) 445-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BEH-000235 | AZ | MD | Behavioral Analyst |
| LCSW-21949 | AZ | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773187200000",
"number": "1417603010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20402 N 15TH AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850273636",
"telephone_number": "623-445-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20402 N 15TH AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850273699",
"telephone_number": "623-445-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENETICH",
"first_name": "GINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-23",
"last_updated": "2026-03-11",
"certification_date": "2026-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "AZ",
"license": "BEH-000235",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AZ",
"license": "LCSW-21949",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.