Healthcare Provider Details

I. General information

NPI: 1881158046
Provider Name (Legal Business Name): DR. BENSFIELD, PSYD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 BURR OAK AVE
NORTH RIVERSIDE IL
60546-1513
US

IV. Provider business mailing address

2428 BURR OAK AVE
NORTH RIVERSIDE IL
60546-1513
US

V. Phone/Fax

Practice location:
  • Phone: 708-906-5478
  • Fax:
Mailing address:
  • Phone: 708-906-5478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA BENSFIELD
Title or Position: OWNER/CLINICAL THERAPIST
Credential: PSYD
Phone: 708-906-5478