Provider Demographics
NPI:1780418715
Name:YALOM, BENJAMIN BLAKE (AMFT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:BLAKE
Last Name:YALOM
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 SOLANA DR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3907
Mailing Address - Country:US
Mailing Address - Phone:415-377-5277
Mailing Address - Fax:
Practice Address - Street 1:1117 SOLANA DR
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3907
Practice Address - Country:US
Practice Address - Phone:415-377-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty