Jacqueline Longley Benton, LGPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LC11602 Issued in MD

Practice address

1208 E Churchville Rd Ste 300
Bel Air, MD 21014-3485

Phone

(410) 893-4600

Fax

(410) 640-4358

NPI assigned

Jan 27, 2019

Last updated

Jun 30, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Safe Harbor Behavioral Care LLCGroup PAC ID 0345514675, 81 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Safe Harbor Behavioral Care, LLC

  • Clinical Social Worker
  • Bel Air, MD
  • NPI 1316487879

  Professional

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1588128292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 CROWN PARK AVE",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208784515",
            "telephone_number": "407-376-8977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 E CHURCHVILLE RD STE 300",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210143485",
            "telephone_number": "410-893-4600",
            "fax_number": "410-640-4358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENTON",
        "first_name": "JACQUELINE",
        "middle_name": "LONGLEY",
        "credential": "LGPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-27",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MD",
            "license": "LGP6827",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC11602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janella Rianna Nolasco Benitez, PHARMD
• Jane Frances Benjes
• James Richard Benke, DO
• Benoptics Inc (Pearle Vision Center)
• Andrew Benson, PT
• Leah Glaspy Benton
• Ashley Bentzel
• Leeba Celia Berger, MS., CCC-SLP
• Meghan Kathleen Berkenstock, M.D.
• Steven Jay Berlin, DPM

• Professional Counselor in Bel Air, MD
• Providers in Bel Air, MD by specialty
• Professional Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.