Provider Demographics
NPI:1245611359
Name:GOLDRICH, BENJAMIN FULMER (MSW)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:FULMER
Last Name:GOLDRICH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 ROUTE 108
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1522
Mailing Address - Country:US
Mailing Address - Phone:603-953-0065
Mailing Address - Fax:603-953-0066
Practice Address - Street 1:8 GREENLEAF WOODS DR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5436
Practice Address - Country:US
Practice Address - Phone:603-422-8208
Practice Address - Fax:603-422-8218
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NH0583101YA0400X
NH25831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14208886OtherCAQH