Provider Demographics
NPI:1013155829
Name:CISROKI, BENJAMIN JOHN IV (BSW)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:JOHN
Last Name:CISROKI
Suffix:IV
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1351 GOOD INTENT RD
Mailing Address - Street 2:#28
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-5401
Mailing Address - Country:US
Mailing Address - Phone:609-319-9536
Mailing Address - Fax:
Practice Address - Street 1:112 N BROAD ST
Practice Address - Street 2:RM 821
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1512
Practice Address - Country:US
Practice Address - Phone:215-568-0860
Practice Address - Fax:215-568-0769
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor