Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37LC00096300 | NJ |
N | 101YP1600X | Pastoral Counselor | 13858 | NJ |
NPI | 1205215498 |
---|---|
Provider Name | Valerie Benjamin |
First Address | Brick, NJ 08724-7118 |
Second Address | Brick, NJ 08724-7118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 08/11/2017 |