Healthcare Provider Details

I. General information

NPI: 1033607569
Provider Name (Legal Business Name): BERIT G BENSON LCSW-S, PMH-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BERIT S GEMAR

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 W RAY RD STE 201
CHANDLER AZ
85226-2472
US

IV. Provider business mailing address

PO BOX 2174
KALAMAZOO MI
49003-2174
US

V. Phone/Fax

Practice location:
  • Phone: 269-312-1446
  • Fax: 269-225-6949
Mailing address:
  • Phone: 693-121-4462
  • Fax: 269-225-6949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.016240
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number62163
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1041C0700X
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22708
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: