Provider Demographics
NPI:1265573877
Name:LARRY J. BENOIT, PH.D., P.C.
Entity type:Organization
Organization Name:LARRY J. BENOIT, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:337-234-4912
Mailing Address - Street 1:119 CAILLOUETT PL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-7807
Mailing Address - Country:US
Mailing Address - Phone:337-234-4912
Mailing Address - Fax:337-234-6064
Practice Address - Street 1:119 CAILLOUETT PL
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-7807
Practice Address - Country:US
Practice Address - Phone:337-234-4912
Practice Address - Fax:337-234-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA541103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S328Medicare UPIN
LA5DX51Medicare UPIN