Provider Demographics
NPI:1851566764
Name:BENSON, CAROLE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:S
Last Name:BENSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E WACKER DR
Mailing Address - Street 2:SUITE 4307
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5104
Mailing Address - Country:US
Mailing Address - Phone:312-565-2609
Mailing Address - Fax:
Practice Address - Street 1:233 E WACKER DR
Practice Address - Street 2:SUITE 4307
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5104
Practice Address - Country:US
Practice Address - Phone:312-565-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002825103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1871614990OtherCORPORATE NPI # FOR BENSON WEINBERG CLINICAL ASSOCIATES, P.C.