Provider Demographics
NPI:1902194863
Name:HEINRICHS, BENJAMIN PAUL (LMHC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:PAUL
Last Name:HEINRICHS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5949 NW 63RD WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1525
Mailing Address - Country:US
Mailing Address - Phone:954-372-6582
Mailing Address - Fax:
Practice Address - Street 1:550 SE 6TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5306
Practice Address - Country:US
Practice Address - Phone:954-372-6582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0058230Medicaid