Provider Demographics
NPI:1396982765
Name:BENSUR, PAUL ALBERT JR (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALBERT
Last Name:BENSUR
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11795 PETTIS RD
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-8556
Mailing Address - Country:US
Mailing Address - Phone:814-807-1551
Mailing Address - Fax:814-336-6411
Practice Address - Street 1:15957 CONNEAUT LAKE RD
Practice Address - Street 2:7
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-4761
Practice Address - Country:US
Practice Address - Phone:814-807-1551
Practice Address - Fax:814-336-6411
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004974101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2090323OtherHIGHMARK