Provider Demographics
NPI:1801141684
Name:BENBEN, JENNIFER MARTIN (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARTIN
Last Name:BENBEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 E MAIN ST
Mailing Address - Street 2:162B
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2116
Mailing Address - Country:US
Mailing Address - Phone:860-575-3389
Mailing Address - Fax:
Practice Address - Street 1:162 E MAIN ST
Practice Address - Street 2:162B
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2116
Practice Address - Country:US
Practice Address - Phone:860-575-3389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001501106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist