Provider Demographics
NPI:1235731555
Name:BENJAMIN DAVIS CREATIVE ARTS THERAPY PLLC
Entity Type:Organization
Organization Name:BENJAMIN DAVIS CREATIVE ARTS THERAPY PLLC
Other - Org Name:FULL SPECTRUM CREATIVE ARTS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:ATR-BC, LCAT
Authorized Official - Phone:917-476-0539
Mailing Address - Street 1:125 EAST 23RD STREET
Mailing Address - Street 2:SUITE 402 #2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:917-476-0539
Mailing Address - Fax:
Practice Address - Street 1:125 E 23RD ST STE 402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4547
Practice Address - Country:US
Practice Address - Phone:917-476-0539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty