Healthcare Provider Details

I. General information

NPI: 1588786974
Provider Name (Legal Business Name): RONALD R BENOIT LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 BROOKSIDE LN
DANBURY NH
03230-4827
US

IV. Provider business mailing address

78 BROOKSIDE LN
DANBURY NH
03230-4827
US

V. Phone/Fax

Practice location:
  • Phone: 603-768-5558
  • Fax:
Mailing address:
  • Phone: 603-768-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1324
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: