Provider Demographics
NPI:1902043011
Name:KOHL, BENJAMIN GIBBS JR (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:GIBBS
Last Name:KOHL
Suffix:JR
Gender:M
Credentials:LCSW-C
Other - Prefix:
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Mailing Address - Street 1:2336 GODDARD PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1126
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6960
Practice Address - Street 1:29520 CANVASBACK DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7124
Practice Address - Country:US
Practice Address - Phone:410-822-5007
Practice Address - Fax:410-822-5569
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD146861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259147-000OtherMAGELLAN
MD522156095OtherUNITED BEHAVIORAL HEALTH
MDLM49EAOtherCAREFIRST BCBS LOCAL
MD522156095OtherUNICARE/NCPPO
MD522156095OtherMANAGED HEALTH NETWORK
MD522156095OtherAETNA
MD522156095OtherMHNET BEHAVIORAL HEALTH
MD609550002Medicaid
MD522156095OtherAMERICAN PSYCH SYSTEM
MD522156095OtherUNITED HEALTH CARE
MD522156095OtherTRICARE
MD609550005Medicaid
MDR968OtherCAREFIRST BCBS FEDERAL
MD522156095OtherUNITED HEALTH CARE