Provider Demographics
NPI:1003294315
Name:BENSTON, JESSICA SUSAN (LCAT, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:SUSAN
Last Name:BENSTON
Suffix:
Gender:F
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 W 21ST ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3203
Mailing Address - Country:US
Mailing Address - Phone:212-592-2755
Mailing Address - Fax:
Practice Address - Street 1:132 W 21ST ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3203
Practice Address - Country:US
Practice Address - Phone:212-592-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY05 001494221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health