Provider Demographics
NPI:1760647549
Name:BENJAMIN, ANNE-MARIE THERESA (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:ANNE-MARIE
Middle Name:THERESA
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4829 SE STEELE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5645
Mailing Address - Country:US
Mailing Address - Phone:503-771-3884
Mailing Address - Fax:
Practice Address - Street 1:4829 SE STEELE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5645
Practice Address - Country:US
Practice Address - Phone:503-771-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional