Provider Demographics
NPI:1104358738
Name:BENNER, JOSEPH (LPC, LADC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BENNER
Suffix:
Gender:M
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 JACQUELINE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2354
Mailing Address - Country:US
Mailing Address - Phone:203-666-1605
Mailing Address - Fax:
Practice Address - Street 1:87 S MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2315
Practice Address - Country:US
Practice Address - Phone:203-666-1605
Practice Address - Fax:475-323-2144
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-02
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1234101YA0400X
CT3519101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health