Provider Demographics
NPI:1326613175
Name:PATNO, BENJAMIN M (LCMHC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:PATNO
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MARIE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-4456
Mailing Address - Country:US
Mailing Address - Phone:802-989-3061
Mailing Address - Fax:
Practice Address - Street 1:486 MAIN ST APT A
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1338
Practice Address - Country:US
Practice Address - Phone:802-989-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0128068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health