Provider Demographics
NPI:1013009869
Name:BENJAMIN, CAMILLE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LETTERS ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-2016
Mailing Address - Country:US
Mailing Address - Phone:860-928-1303
Mailing Address - Fax:
Practice Address - Street 1:32 LETTERS ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-2016
Practice Address - Country:US
Practice Address - Phone:860-928-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSW2027128-21041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1013009869Medicaid
CT009854Medicaid