Provider Demographics
NPI:1467068395
Name:BENJAMIN, SAMSON ADAM JR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:SAMSON
Middle Name:ADAM
Last Name:BENJAMIN
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:BENJAMIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:414 YALE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4357
Mailing Address - Country:US
Mailing Address - Phone:909-667-0940
Mailing Address - Fax:
Practice Address - Street 1:414 YALE AVE STE D
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4357
Practice Address - Country:US
Practice Address - Phone:909-667-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist