Healthcare Provider Details

I. General information

NPI: 1174694608
Provider Name (Legal Business Name): MOLLY A BENSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/23/2021
Certification Date: 10/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MAIN ST STE 7
CONCORD MA
01742-3319
US

IV. Provider business mailing address

801 MAIN ST STE 7
CONCORD MA
01742-3319
US

V. Phone/Fax

Practice location:
  • Phone: 781-325-8247
  • Fax:
Mailing address:
  • Phone: 781-325-8247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8471
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8471
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: