Healthcare Provider Details

I. General information

NPI: 1679778864
Provider Name (Legal Business Name): BEN C PRYOR CADCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. BEN C PRYOR

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BEN PRYOR 998 VIRGINIA ST
BERKELEY CA
94710-1851
US

IV. Provider business mailing address

1931 CENTER ST
BERKELEY CA
94704-1105
US

V. Phone/Fax

Practice location:
  • Phone: 510-684-1922
  • Fax:
Mailing address:
  • Phone: 510-666-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier61552
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerAC BHCS CLINICIAN#

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: