Provider Demographics
NPI:1467840033
Name:BENSON, KIMBERLY (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PENATAQUIT PL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2415
Mailing Address - Country:US
Mailing Address - Phone:631-404-8152
Mailing Address - Fax:
Practice Address - Street 1:972 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1612
Practice Address - Country:US
Practice Address - Phone:631-404-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2018-12-19
Deactivation Date:2018-10-09
Deactivation Code:
Reactivation Date:2018-12-19
Provider Licenses
StateLicense IDTaxonomies
NY0873191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical