Healthcare Provider Details

I. General information

NPI: 1699210492
Provider Name (Legal Business Name): ASHLEY P BENSON, LICSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MASS MOCA WAY
NORTH ADAMS MA
01247-2446
US

IV. Provider business mailing address

132 MASS MOCA WAY
NORTH ADAMS MA
01247-2446
US

V. Phone/Fax

Practice location:
  • Phone: 413-464-5408
  • Fax: 413-664-4660
Mailing address:
  • Phone: 413-464-5408
  • Fax: 413-664-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117410
License Number StateMA

VIII. Authorized Official

Name: ASHLEY P BENSON
Title or Position: OWNER
Credential: LICSW
Phone: 413-464-5408