Provider Demographics
NPI:1043386618
Name:LESCZYNSKI, BEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:LESCZYNSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST,
Mailing Address - Street 2:49 MDG/ SGOW HOLLOMAN AFB
Mailing Address - City:HOLLOMAN
Mailing Address - State:NM
Mailing Address - Zip Code:88330
Mailing Address - Country:US
Mailing Address - Phone:575-572-1968
Mailing Address - Fax:575-572-2259
Practice Address - Street 1:280 1ST ST
Practice Address - Street 2:49 MDG/ SGOW HOLLOMAN AFB
Practice Address - City:HOLLOMAN AIR FORCE BASE
Practice Address - State:NM
Practice Address - Zip Code:88330-8273
Practice Address - Country:US
Practice Address - Phone:575-572-1968
Practice Address - Fax:575-572-2259
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
NM1384103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program