Provider Demographics
NPI:1407100803
Name:ALEXANDER-EITZMAN, BENJAMIN EDWIN (LCSW, PHD)
Entity Type:Individual
Prefix:PROF
First Name:BENJAMIN
Middle Name:EDWIN
Last Name:ALEXANDER-EITZMAN
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:EDWIN
Other - Last Name:EITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:114 CRESTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6415
Mailing Address - Country:US
Mailing Address - Phone:828-355-9643
Mailing Address - Fax:
Practice Address - Street 1:114 CRESTVIEW LN
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6415
Practice Address - Country:US
Practice Address - Phone:828-355-9643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0029541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical