Provider Demographics
NPI:1467670679
Name:BENJAMIN, MARIE EMELINE
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:EMELINE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OLD HICKORY TRL
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2242
Mailing Address - Country:US
Mailing Address - Phone:972-298-7323
Mailing Address - Fax:
Practice Address - Street 1:2000 OLD HICKORY TRL
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2242
Practice Address - Country:US
Practice Address - Phone:972-298-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health