Provider Demographics
NPI:1144505561
Name:SELIGMAN, BENJAMIN BARRY (LICSW)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:BARRY
Last Name:SELIGMAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01036-9106
Mailing Address - Country:US
Mailing Address - Phone:413-566-5041
Mailing Address - Fax:
Practice Address - Street 1:465 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:MA
Practice Address - Zip Code:01036-9106
Practice Address - Country:US
Practice Address - Phone:413-566-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017156101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1017156OtherLICSW