Healthcare Provider Details

I. General information

NPI: 1316451479
Provider Name (Legal Business Name): BENJAMIN E BLINDER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CROOKS RD
TROY MI
48084-4733
US

IV. Provider business mailing address

4444 2ND AVE
DETROIT MI
48201-1216
US

V. Phone/Fax

Practice location:
  • Phone: 248-731-7305
  • Fax:
Mailing address:
  • Phone: 248-679-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119917
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: