Healthcare Provider Details

I. General information

NPI: 1669699062
Provider Name (Legal Business Name): BENJAMIN EWING M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 N 7TH ST
PHOENIX AZ
85006-2133
US

IV. Provider business mailing address

4020 E WELDON AVE
PHOENIX AZ
85018-5951
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-3805
  • Fax:
Mailing address:
  • Phone: 602-452-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: