Healthcare Provider Details

I. General information

NPI: 1245899863
Provider Name (Legal Business Name): MATTHEW FRANCIS BENOIT LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6548 TOWN CENTER DR STE D
CLARKSTON MI
48346-4823
US

IV. Provider business mailing address

5875 ROCKCROFT BLVD
CLARKSTON MI
48346-3440
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone: 248-372-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301017782
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361007563
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: