Provider Demographics
NPI:1144378548
Name:BENTON, ROBERT J. (LP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT J.
Middle Name:
Last Name:BENTON
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 JANE ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-5116
Mailing Address - Country:US
Mailing Address - Phone:212-645-3024
Mailing Address - Fax:
Practice Address - Street 1:56 JANE ST APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-5116
Practice Address - Country:US
Practice Address - Phone:212-645-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000059103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis