Provider Demographics
NPI:1598418378
Name:MBUYAMBA, BENINE MUDYMBA (LCSW)
Entity type:Individual
Prefix:
First Name:BENINE
Middle Name:MUDYMBA
Last Name:MBUYAMBA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HEALTHCARE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9445
Mailing Address - Country:US
Mailing Address - Phone:207-282-4270
Mailing Address - Fax:207-294-8332
Practice Address - Street 1:9 HEALTHCARE DR STE 101
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9445
Practice Address - Country:US
Practice Address - Phone:207-282-4270
Practice Address - Fax:207-294-8332
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC250641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical