Provider Demographics
NPI:1134881451
Name:SAFSTROM, BENJAMIN BLISS
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:BLISS
Last Name:SAFSTROM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 CHESAPEAKE PL
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-3786
Mailing Address - Country:US
Mailing Address - Phone:805-765-7112
Mailing Address - Fax:
Practice Address - Street 1:640 CHESAPEAKE PL
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-3786
Practice Address - Country:US
Practice Address - Phone:805-765-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health