Provider Demographics
NPI:1821101924
Name:BENSON, ANNA LEE (PHD CLINICAL PSYCHOL)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:LEE
Last Name:BENSON
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:SANTA YSABEL
Mailing Address - State:CA
Mailing Address - Zip Code:92070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30240 HWY 78
Practice Address - Street 2:
Practice Address - City:SANTA YSABEL
Practice Address - State:CA
Practice Address - Zip Code:92070
Practice Address - Country:US
Practice Address - Phone:760-765-3578
Practice Address - Fax:760-765-2810
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11686103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY116862Medicaid
R95146Medicare UPIN
CACP11686AMedicare ID - Type Unspecified