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General NPI Number Information
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NPI Number | 1003669284
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Entity Type | Individual
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Provider Name | BENJAMIN ELIOT LISTON LMHC
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Gender | Male
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 13 HIGHLAND ST
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City | WESTON
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State | MA
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Zip | 02493-1185
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Country | US
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Telephone | 781-605-4012
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Fax |
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Provider Business Mailing Address
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Address Line | 588 BOSTON POST RD STE 365
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City | WESTON
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State | MA
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Zip | 02493-1535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMHC5000816
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License Number State | MA
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