Healthcare Provider Details

I. General information

NPI: 1376540815
Provider Name (Legal Business Name): DEBORAH M. BENSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 OLD COUNTRY ROAD
PLAINVIEW NY
11803
US

IV. Provider business mailing address

9495 BLIND PASS RD UNIT PH1
ST PETE BEACH FL
33706-1352
US

V. Phone/Fax

Practice location:
  • Phone: 516-586-4480
  • Fax:
Mailing address:
  • Phone: 631-673-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number011725
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number011725
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02187277
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: