Provider Demographics
NPI:1710039979
Name:BENJAMIN, DOREEN DIANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:DIANE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 LAKEVIEW PKWY STE 165
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1444
Mailing Address - Country:US
Mailing Address - Phone:847-867-7236
Mailing Address - Fax:847-549-8006
Practice Address - Street 1:977 LAKEVIEW PKWY STE 165
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1444
Practice Address - Country:US
Practice Address - Phone:847-867-7236
Practice Address - Fax:847-549-8006
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006789103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical