Provider Demographics
NPI:1073743126
Name:BENJAMIN, TODD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2476 OCEANSIDE RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1537
Mailing Address - Country:US
Mailing Address - Phone:516-536-9732
Mailing Address - Fax:516-536-5391
Practice Address - Street 1:2476 OCEANSIDE RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1537
Practice Address - Country:US
Practice Address - Phone:516-536-9732
Practice Address - Fax:516-536-5391
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25831101YA0400X, 101YM0800X, 1041S0200X, 106H00000X
258311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist