Provider Demographics
NPI:1598879751
Name:BENSON, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1725
Mailing Address - Country:US
Mailing Address - Phone:716-285-1904
Mailing Address - Fax:716-284-8262
Practice Address - Street 1:419 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1725
Practice Address - Country:US
Practice Address - Phone:716-285-1904
Practice Address - Fax:716-284-8262
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY51763681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020036902OtherUNIVERA
NY000511341002OtherBC
NY050709000006OtherFIDELIS
NY6207655OtherIHA
NY00020036902OtherUNIVERA