Provider Demographics
NPI:1720190465
Name:BENSON, SUSAN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-2234
Mailing Address - Country:US
Mailing Address - Phone:401-245-5745
Mailing Address - Fax:401-289-0287
Practice Address - Street 1:5 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-2234
Practice Address - Country:US
Practice Address - Phone:401-245-5745
Practice Address - Fax:401-289-0287
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMFT00066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0133960OtherNHP
RI26603-9OtherBLUE CROSS/ BLUE SHIELD
RI410575OtherBLUE CHIP
RI017595OtherVALUE OPTIONS
RI62-97347OtherUNITED BEHAVIORAL HEALTH
RI2183021OtherCIGNA
RI0007611562OtherAETNA