Healthcare Provider Details

I. General information

NPI: 1003669284
Provider Name (Legal Business Name): BENJAMIN ELIOT LISTON LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 HIGHLAND ST
WESTON MA
02493-1185
US

IV. Provider business mailing address

588 BOSTON POST RD STE 365
WESTON MA
02493-1535
US

V. Phone/Fax

Practice location:
  • Phone: 781-605-4012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC5000816
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: