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General NPI Number Information
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NPI Number | 1073903738
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Entity Type | Individual
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Provider Name | BENJAMIN CORNELL PSYD
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Gender | Male
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 3336 S CLAY ST
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City | ENGLEWOOD
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State | CO
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Zip | 80110-1928
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Country | US
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Telephone | 818-933-1562
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Fax |
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Provider Business Mailing Address
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Address Line | 640 LINDEN CRK
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City | MORROW
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State | OH
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Zip | 45152-8451
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Country | US
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Telephone | 818-933-1562
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 60906097
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License Number State | WA
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