Healthcare Provider Details

I. General information

NPI: 1801700810
Provider Name (Legal Business Name): BENJAMIN MATTHEW STRAND LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAIN ST STE 654
PUEBLO CO
81003-3132
US

IV. Provider business mailing address

2016 W 16TH ST
PUEBLO CO
81003-1230
US

V. Phone/Fax

Practice location:
  • Phone: 719-766-9362
  • Fax:
Mailing address:
  • Phone: 719-649-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933874
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: