Provider Demographics
NPI:1356561005
Name:BENOIST, IRVING (PHD LP)
Entity type:Individual
Prefix:DR
First Name:IRVING
Middle Name:
Last Name:BENOIST
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:MS
Other - First Name:IRVING
Other - Middle Name:BENOIST
Other - Last Name:BLOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4104 HARRIET AV SO
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1443
Mailing Address - Country:US
Mailing Address - Phone:612-823-8715
Mailing Address - Fax:
Practice Address - Street 1:430 OAK GROVE ST
Practice Address - Street 2:SUITE 216
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403
Practice Address - Country:US
Practice Address - Phone:612-870-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1909103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
01192BEOtherBCBS MN
68000050Medicare ID - Type Unspecified