Healthcare Provider Details

I. General information

NPI: 1679089171
Provider Name (Legal Business Name): ERIC ROBERT BENSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WORCESTER ST
NORTH GRAFTON MA
01536-1041
US

IV. Provider business mailing address

6 ANGELS WAY
HOPKINTON MA
01748-2171
US

V. Phone/Fax

Practice location:
  • Phone: 508-282-2784
  • Fax:
Mailing address:
  • Phone: 508-282-2784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10717
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number10717
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: