Provider Demographics
NPI:1932268349
Name:BENSON, REGINA (LCSW LMFT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 BLOOMFIELD AVENUE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7585
Mailing Address - Country:US
Mailing Address - Phone:973-228-4885
Mailing Address - Fax:973-777-3813
Practice Address - Street 1:616 BLOOMFIELD AVENUE
Practice Address - Street 2:SUITE 3A
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7585
Practice Address - Country:US
Practice Address - Phone:973-228-4885
Practice Address - Fax:973-777-3813
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001712001041C0700X
NJ37FI00096200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
053355OtherVALUE OPTIONS
P1053079OtherOXFORD
128368OtherNEW DIRECTIONS BEHAVIORAL
053355OtherVALUE OPTIONS
S15196Medicare UPIN