Provider Demographics
NPI:1083877815
Name:BENSON, GREGORY SCOTT (MA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SCOTT
Last Name:BENSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:SCOTT
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2616 N FREDERICK AVE APT 323
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3614
Mailing Address - Country:US
Mailing Address - Phone:414-213-9190
Mailing Address - Fax:
Practice Address - Street 1:1545 S LAYTON BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1924
Practice Address - Country:US
Practice Address - Phone:414-671-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling