Provider Demographics
NPI:1073647285
Name:BENJAMIN, BETTY GAE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:GAE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PARK AVE
Mailing Address - Street 2:SUMMIT HILLS
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1107
Mailing Address - Country:US
Mailing Address - Phone:845-354-8847
Mailing Address - Fax:
Practice Address - Street 1:13 PARK AVE
Practice Address - Street 2:SUMMIT HILLS
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1107
Practice Address - Country:US
Practice Address - Phone:845-354-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049192-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP575338OtherOXFORD HEALTH PLANS
NYP836234OtherOXFORD HEALTH PLANS