Provider Demographics
NPI:1841424538
Name:MEADE, BENJAMIN P (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:P
Last Name:MEADE
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SW NYE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3821
Mailing Address - Country:US
Mailing Address - Phone:541-265-0445
Mailing Address - Fax:
Practice Address - Street 1:4422 NE DEVILS LAKE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5000
Practice Address - Country:US
Practice Address - Phone:541-265-4196
Practice Address - Fax:541-994-1882
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL57481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500664110Medicaid