Provider Demographics
NPI:1619091444
Name:BENJAMIN, MARY K (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 TYLER DR
Mailing Address - Street 2:
Mailing Address - City:OXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01589
Mailing Address - Country:US
Mailing Address - Phone:401-419-5147
Mailing Address - Fax:508-377-4106
Practice Address - Street 1:291 MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:401-419-5147
Practice Address - Fax:508-377-4106
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW010011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical