Healthcare Provider Details

I. General information

NPI: 1346729514
Provider Name (Legal Business Name): JENNIFER ANNE BENGER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 BELMONT ST
WORCESTER MA
01604-1059
US

IV. Provider business mailing address

309 BELMONT ST
WORCESTER MA
01604-1059
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-3483
  • Fax: 508-363-1515
Mailing address:
  • Phone: 508-368-3483
  • Fax: 508-363-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS015615
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: