Dominique Benavidez, PH.D.

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

License

RPS2005098 Issued in CA

Practice address

335 Redondo Ave
Long Beach, CA 90814

Phone

(562) 434-3030

Fax

(562) 434-3212

NPI assigned

Mar 29, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Clinical Psychologist

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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

• Dominique Benavidez Psychology Consultant and Associates

  • Clinical Psychologist
  • Torrance, CA
  • NPI 1609118165
  NPD (past) Authorized official
• Branko Radisavljevic M.D. Inc.

  • Psychiatry Physician
  • Long Beach, CA
  • NPI 1982941902
  NPD (past)

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530057600000",
    "number": "1740309525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 SILVER SPUR RD # 297",
            "city": "ROLLING HILLS ESTATES",
            "state": "CA",
            "postal_code": "902743800",
            "telephone_number": "310-373-0800",
            "fax_number": "310-373-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 REDONDO AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "90814",
            "telephone_number": "562-434-3030",
            "fax_number": "562-434-3212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "335 Redondo Ave",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908142652",
            "country_code": "US",
            "telephone_number": "562-434-3030",
            "fax_number": "562-434-3212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENAVIDEZ",
        "first_name": "DOMINIQUE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "CA",
            "license": "22620",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "22620",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "22620",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "22620",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "CA",
            "license": "RPS2005098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Benaderet
• Teresa Scherr Benard, MSA
• Martine Benatar, M.A., L.M.F.T.
• Carlos Fabricio Benavides, LCSW135470
• Sabrina Pearl Benavides
• Camryn Benbow
• Kassandra Rae Nobles Bencito
• Alexis Benedict
• Matthew D. Benedict, M.D.
• Benevolence Industries Inc.

• Intellectual & Developmental Disabilities Psychologist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Intellectual & Developmental Disabilities Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; 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.