Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 011725 | NY |
Y | 103TC0700X | Clinical Psychologist | 011725 | NY |
N | 103TR0400X | Rehabilitation Psychologist | 011725 | NY |
NPI | 1376540815 |
---|---|
Provider Name | Dr. Deborah M. Benson |
First Address | St Pete Beach, FL 33706-1352 |
Second Address | Plainview, NY 11803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 05/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02187277 | (05) | NY |