Healthcare Provider Details

I. General information

NPI: 1699317719
Provider Name (Legal Business Name): BENSON K. MBOCHE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 FALLS RD
BALTIMORE MD
21211-1844
US

IV. Provider business mailing address

3730 FALLS RD
BALTIMORE MD
21211-1844
US

V. Phone/Fax

Practice location:
  • Phone: 443-629-8645
  • Fax:
Mailing address:
  • Phone: 443-629-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR183057
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR183057
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: