Healthcare Provider Details

I. General information

NPI: 1962347559
Provider Name (Legal Business Name): GWYNNETH BENSEN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 FRONT ST
SCOTCH PLAINS NJ
07076-1103
US

IV. Provider business mailing address

1812 FRONT ST
SCOTCH PLAINS NJ
07076-1103
US

V. Phone/Fax

Practice location:
  • Phone: 201-350-7532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00942500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: