Provider Demographics
NPI:1083332746
Name:NAUCEDER, BENJAMIN ELIAS (CLC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ELIAS
Last Name:NAUCEDER
Suffix:
Gender:M
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29010-1424
Mailing Address - Country:US
Mailing Address - Phone:603-359-3686
Mailing Address - Fax:
Practice Address - Street 1:104 RIDGE ST
Practice Address - Street 2:
Practice Address - City:BISHOPVILLE
Practice Address - State:SC
Practice Address - Zip Code:29010-1424
Practice Address - Country:US
Practice Address - Phone:603-359-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH326292174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN