Provider Demographics
NPI:1306371976
Name:SAXE, BENJAMIN (MA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SAXE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4793 PICKERING RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3578
Mailing Address - Country:US
Mailing Address - Phone:248-914-7800
Mailing Address - Fax:
Practice Address - Street 1:4793 PICKERING RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3578
Practice Address - Country:US
Practice Address - Phone:248-914-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health