Provider Demographics
NPI:1205328390
Name:MUNYAN, BENSON GEORGE III (PHD)
Entity type:Individual
Prefix:DR
First Name:BENSON
Middle Name:GEORGE
Last Name:MUNYAN
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 MEADOW BRANCH DR APT 417
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5055
Mailing Address - Country:US
Mailing Address - Phone:435-760-5789
Mailing Address - Fax:
Practice Address - Street 1:3564 AVALON PARK E BLVD STE 1
Practice Address - Street 2:IPMB 3039
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-3282
Practice Address - Country:US
Practice Address - Phone:321-754-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
AZPSY-005031103TC0700X
FLPY10498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1AOUIOtherFLORIDA BLUE