=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205215498
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALERIE BENJAMIN LCADC CCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2015
-----------------------------------------------------
Last Update Date | 11/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1348 ISABELLA CT
-----------------------------------------------------
City | BRICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08724-7118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-688-3298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1348 ISABELLA CT
-----------------------------------------------------
City | BRICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08724-7118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-688-3298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP1600X
-----------------------------------------------------
Taxonomy Name | Pastoral Counselor
-----------------------------------------------------
License Number | 13858
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 37LC00096300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------