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General NPI Number Information
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NPI Number | 1104358738
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Entity Type | Individual
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Provider Name | JOSEPH BENNER LPC, LADC
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Gender | Male
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Dates
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Enumeration Date | 04/02/2017
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 87 S MAIN ST STE 14
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City | NEWTOWN
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State | CT
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Zip | 06470-2315
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Country | US
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Telephone | 203-666-1605
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Fax | 475-323-2144
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Provider Business Mailing Address
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Address Line | 215 JACQUELINE DR
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City | SOUTHBURY
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State | CT
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Zip | 06488-2354
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Country | US
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Telephone | 203-666-1605
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1234
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3519
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3519
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License Number State | CT
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