Provider Demographics
NPI:1942923149
Name:BENSON, TEKLA MARY (MPS, LCAT - P)
Entity Type:Individual
Prefix:
First Name:TEKLA
Middle Name:MARY
Last Name:BENSON
Suffix:
Gender:F
Credentials:MPS, LCAT - P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 85TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4604
Mailing Address - Country:US
Mailing Address - Phone:917-588-1185
Mailing Address - Fax:
Practice Address - Street 1:901 80TH ST APT 3L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2640
Practice Address - Country:US
Practice Address - Phone:917-588-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP114846103TC0700X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical