Provider Demographics
NPI:1073003398
Name:BENJAMIN, UMU (ARNP-PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:UMU
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:ARNP-PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20168-0730
Mailing Address - Country:US
Mailing Address - Phone:703-662-5383
Mailing Address - Fax:877-630-8935
Practice Address - Street 1:14658 GAP WAY, HAYMARKET, VA 20169
Practice Address - Street 2:#730
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20168-0730
Practice Address - Country:US
Practice Address - Phone:703-662-5383
Practice Address - Fax:877-630-8935
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 1041C0700X
VA0024176104363LP0808X
MDAC002426363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical