Provider Demographics
NPI:1619645306
Name:CECIL, BENJAMIN MOFFITT (LCSW)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MOFFITT
Last Name:CECIL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HUMBOLDT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4103
Mailing Address - Country:US
Mailing Address - Phone:917-273-1987
Mailing Address - Fax:
Practice Address - Street 1:650 HUMBOLDT ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4103
Practice Address - Country:US
Practice Address - Phone:917-273-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0912321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical