Provider Demographics
NPI:1205341823
Name:BENSON, TINA MARIE (MA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:BENSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HILLCREST CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1505
Mailing Address - Country:US
Mailing Address - Phone:415-215-2422
Mailing Address - Fax:
Practice Address - Street 1:33 MILLWOOD ST
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2037
Practice Address - Country:US
Practice Address - Phone:415-488-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty