Provider Demographics
NPI:1639876584
Name:BENJAMIN GOITZ MENTAL HEALTH COUNSELING, PLLC
Entity Type:Organization
Organization Name:BENJAMIN GOITZ MENTAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LIBRO
Authorized Official - Last Name:GOITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:518-407-3291
Mailing Address - Street 1:109 BEVERWYCK DR APT 9
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9678
Mailing Address - Country:US
Mailing Address - Phone:518-526-4126
Mailing Address - Fax:
Practice Address - Street 1:125 ADAMS ST STE 1
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-3211
Practice Address - Country:US
Practice Address - Phone:518-407-3291
Practice Address - Fax:518-475-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty