Provider Demographics
NPI:1235876194
Name:METH, MICHAEL BENSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BENSON
Last Name:METH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 WESTGATE CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2093
Mailing Address - Country:US
Mailing Address - Phone:954-817-3036
Mailing Address - Fax:
Practice Address - Street 1:512 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7012
Practice Address - Country:US
Practice Address - Phone:954-817-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11479103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist