Provider Demographics
NPI:1255659918
Name:CONFORTI, BENJAMIN KEITH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:KEITH
Last Name:CONFORTI
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 1:211 PLEASANT HOME RD
Mailing Address - Street 2:BLDG G1
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0518
Mailing Address - Country:US
Mailing Address - Phone:706-364-5228
Mailing Address - Fax:706-364-5229
Practice Address - Street 1:211 PLEASANT HOME RD
Practice Address - Street 2:BLDG G1
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-0518
Practice Address - Country:US
Practice Address - Phone:706-364-5228
Practice Address - Fax:706-364-5229
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003356103TC2200X
TX36033103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent