Provider Demographics
NPI:1265948400
Name:BENJAMIN, REBECCA ANN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4511 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-9659
Mailing Address - Country:US
Mailing Address - Phone:616-402-3669
Mailing Address - Fax:616-954-1520
Practice Address - Street 1:2100 RAYBROOK ST SE STE 203
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5783
Practice Address - Country:US
Practice Address - Phone:616-954-1555
Practice Address - Fax:616-954-1520
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010938921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical