Provider Demographics
NPI:1851874911
Name:BENJAMIN, HEATHER ANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHANDLER RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4203
Mailing Address - Country:US
Mailing Address - Phone:617-792-1884
Mailing Address - Fax:
Practice Address - Street 1:9 CHANDLER RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4203
Practice Address - Country:US
Practice Address - Phone:617-792-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116992-1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA116992-SW-LICSWOtherLICSW
MA116992-SW-LICSWOtherLICSW