Provider Demographics
NPI:1225652068
Name:BENJAMIN PSYCHOLOGICAL SERVICES AND CONSULTING LLC
Entity Type:Organization
Organization Name:BENJAMIN PSYCHOLOGICAL SERVICES AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-413-9043
Mailing Address - Street 1:435 W MAIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2440
Mailing Address - Country:US
Mailing Address - Phone:516-413-9043
Mailing Address - Fax:
Practice Address - Street 1:157 CHURCH ST FL 19
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2100
Practice Address - Country:US
Practice Address - Phone:516-413-9043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health