Healthcare Provider Details

I. General information

NPI: 1528059870
Provider Name (Legal Business Name): CARLENE BENSON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 SAGINAW ST S
SALEM OR
97302-4121
US

IV. Provider business mailing address

821 SAGINAW ST S
SALEM OR
97302-4121
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-1761
  • Fax: 503-362-9671
Mailing address:
  • Phone: 503-399-1761
  • Fax: 503-362-9671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberOR 950
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: