Provider Demographics
NPI:1184123572
Name:STROGATZ, BENJAMIN LIBSON (MSS, LSW)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LIBSON
Last Name:STROGATZ
Suffix:
Gender:M
Credentials:MSS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S 19TH ST APT 7B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2580
Mailing Address - Country:US
Mailing Address - Phone:215-460-5600
Mailing Address - Fax:
Practice Address - Street 1:1500 WALNUT ST STE 300
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3502
Practice Address - Country:US
Practice Address - Phone:215-563-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1350101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical