Provider Demographics
NPI:1750152021
Name:BENSCOTER, JUSTINE R (MSW, LSW)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:R
Last Name:BENSCOTER
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 MAIN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:TULLYTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19007-6215
Mailing Address - Country:US
Mailing Address - Phone:215-280-5891
Mailing Address - Fax:
Practice Address - Street 1:320 MAIN ST APT 4
Practice Address - Street 2:
Practice Address - City:TULLYTOWN
Practice Address - State:PA
Practice Address - Zip Code:19007-6215
Practice Address - Country:US
Practice Address - Phone:215-280-5891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW141103101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)