Provider Demographics
NPI:1831663566
Name:GOITZ, BENJAMIN LIBRO (MSED)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LIBRO
Last Name:GOITZ
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6216
Mailing Address - Country:US
Mailing Address - Phone:518-526-4126
Mailing Address - Fax:
Practice Address - Street 1:945 PALMER AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6216
Practice Address - Country:US
Practice Address - Phone:518-526-4126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health