Provider Demographics
NPI:1770830119
Name:GERRARD, BENJAMIN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:GERRARD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 C OF E DR STE 115
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2579
Mailing Address - Country:US
Mailing Address - Phone:706-372-6315
Mailing Address - Fax:
Practice Address - Street 1:1420 C OF E DR STE 115
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2579
Practice Address - Country:US
Practice Address - Phone:706-372-6315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8571101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health