Provider Demographics
NPI:1275064123
Name:BENSTON, SUSAN FAITH (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:FAITH
Last Name:BENSTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 S BURDICK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-5802
Mailing Address - Country:US
Mailing Address - Phone:269-381-4552
Mailing Address - Fax:269-381-9096
Practice Address - Street 1:3608 S BURDICK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4838
Practice Address - Country:US
Practice Address - Phone:269-381-4552
Practice Address - Fax:269-381-9096
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010834311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical