Provider Demographics
NPI:1942666524
Name:BEN1818LLC
Entity Type:Organization
Organization Name:BEN1818LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENYAMINOV
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:718-640-5668
Mailing Address - Street 1:2700 WILLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3103
Mailing Address - Country:US
Mailing Address - Phone:718-640-5668
Mailing Address - Fax:
Practice Address - Street 1:2700 WILLOW GLEN DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3103
Practice Address - Country:US
Practice Address - Phone:718-640-5668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17516251E00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health