Provider Demographics
NPI:1629407267
Name:PAGE, BENJAMIN (PSYD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94042-0901
Mailing Address - Country:US
Mailing Address - Phone:650-596-2601
Mailing Address - Fax:
Practice Address - Street 1:117 S CALIFORNIA AVE
Practice Address - Street 2:SUITE D201
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-5103
Practice Address - Country:US
Practice Address - Phone:650-596-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25964103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical