Provider Demographics
NPI:1780834796
Name:NEALE, BENJAMIN HOMAN (PSYD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HOMAN
Last Name:NEALE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-5004
Mailing Address - Country:US
Mailing Address - Phone:415-244-3960
Mailing Address - Fax:
Practice Address - Street 1:615 N NEVADA AVE STE 4
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1075
Practice Address - Country:US
Practice Address - Phone:719-505-2461
Practice Address - Fax:719-634-2563
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004437103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical