Provider Demographics
NPI:1770529331
Name:BENJAMIN, RUBY R (EDD08/14/1931)
Entity type:Individual
Prefix:DR
First Name:RUBY
Middle Name:R
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:EDD08/14/1931
Other - Prefix:
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Mailing Address - Street 1:205 WEST END AVENUE
Mailing Address - Street 2:/SUITE 24L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4825
Mailing Address - Country:US
Mailing Address - Phone:212-721-5744
Mailing Address - Fax:212-721-0013
Practice Address - Street 1:205 W END AVE
Practice Address - Street 2:/SUITE 24L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4804
Practice Address - Country:US
Practice Address - Phone:212-721-5744
Practice Address - Fax:212-721-0013
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY19-000334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health