Healthcare Provider Details

I. General information

NPI: 1316978935
Provider Name (Legal Business Name): LARRY JAMES BENOIT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CAILLOUETT PL
LAFAYETTE LA
70501-7807
US

IV. Provider business mailing address

119 CAILLOUETT PL
LAFAYETTE LA
70501-7807
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-4912
  • Fax: 337-234-6064
Mailing address:
  • Phone: 337-234-4912
  • Fax: 337-234-6064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number541
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number541
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number541
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number541
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number541
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: