Provider Demographics
NPI:1356745004
Name:PROBST, BENJAMIN EDWARD (LMSW)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:EDWARD
Last Name:PROBST
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7082 LIGHT RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-9781
Mailing Address - Country:US
Mailing Address - Phone:716-338-0033
Mailing Address - Fax:716-338-1575
Practice Address - Street 1:20 W FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750-1702
Practice Address - Country:US
Practice Address - Phone:716-338-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 078938104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker