Provider Demographics
NPI:1578980538
Name:BENJAMIN, STEPHANIE K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:K
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:K
Other - Last Name:POGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:435 W MAIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2440
Mailing Address - Country:US
Mailing Address - Phone:516-413-9043
Mailing Address - Fax:
Practice Address - Street 1:157 CHURCH ST FL 19
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2100
Practice Address - Country:US
Practice Address - Phone:516-413-9043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023102103TC0700X
CT3861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical