Provider Demographics
NPI:1578747291
Name:BENSON, NANCY (LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3142
Mailing Address - Country:US
Mailing Address - Phone:860-712-9812
Mailing Address - Fax:
Practice Address - Street 1:50 ALBANY TPKE
Practice Address - Street 2:BUILDING #5 2ND FLOOR
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2516
Practice Address - Country:US
Practice Address - Phone:860-712-9812
Practice Address - Fax:860-693-1559
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional