Healthcare Provider Details

I. General information

NPI: 1922839612
Provider Name (Legal Business Name): BENJAMIN FARBER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PL STE 321
BROOKLINE MA
02445-7237
US

IV. Provider business mailing address

1486 COMMONWEALTH AVE APT 15
BRIGHTON MA
02135-4527
US

V. Phone/Fax

Practice location:
  • Phone: 781-201-3914
  • Fax:
Mailing address:
  • Phone: 609-923-7694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2140453
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: