Healthcare Provider Details

I. General information

NPI: 1578160685
Provider Name (Legal Business Name): NANCY BENIGSOHN LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 11/18/2024
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLUE JAY COUNSELING 1850 CALLE MEDICO
SANTA FE NM
87505
US

IV. Provider business mailing address

6404 JAGUAR DR
SANTA FE NM
87507-1702
US

V. Phone/Fax

Practice location:
  • Phone: 505-570-2116
  • Fax:
Mailing address:
  • Phone: 505-819-8481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTL0213111
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2024-0574
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: