Provider Demographics
NPI:1205215498
Name:BENJAMIN, VALERIE (LCADC CCS)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LCADC CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 ISABELLA CT
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7118
Mailing Address - Country:US
Mailing Address - Phone:732-688-3298
Mailing Address - Fax:
Practice Address - Street 1:1348 ISABELLA CT
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7118
Practice Address - Country:US
Practice Address - Phone:732-688-3298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ13858101YP1600X
NJ37LC00096300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral