Provider Demographics
NPI:1356315816
Name:BENTON, FAITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:FAITH
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-0051
Mailing Address - Country:US
Mailing Address - Phone:781-648-9202
Mailing Address - Fax:
Practice Address - Street 1:94 PLEASANT ST
Practice Address - Street 2:SUITE 10
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6535
Practice Address - Country:US
Practice Address - Phone:617-233-8186
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6877103TC0700X
NH441103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51056Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NHRE3954Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER