Provider Demographics
NPI:1265749675
Name:BENSON, JILL K (LMSW)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:K
Last Name:BENSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 LOMBARD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4859
Mailing Address - Country:US
Mailing Address - Phone:917-817-7032
Mailing Address - Fax:
Practice Address - Street 1:856 DELAFIELD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2237
Practice Address - Country:US
Practice Address - Phone:917-817-7032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070801-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker