Provider Demographics
NPI:1033607569
Name:BENSON, BERIT G (LCSW-S, PMH-C)
Entity Type:Individual
Prefix:MRS
First Name:BERIT
Middle Name:G
Last Name:BENSON
Suffix:
Gender:F
Credentials:LCSW-S, PMH-C
Other - Prefix:
Other - First Name:BERIT
Other - Middle Name:S
Other - Last Name:GEMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2174
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49003-2174
Mailing Address - Country:US
Mailing Address - Phone:693-121-4462
Mailing Address - Fax:269-225-6949
Practice Address - Street 1:1125 E MILHAM AVE STE B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3096
Practice Address - Country:US
Practice Address - Phone:269-312-1446
Practice Address - Fax:269-225-6949
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0162401041C0700X
TX621631041C0700X
MI1041C0700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical