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General NPI Number Information
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NPI Number | 1205328390
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Entity Type | Individual
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Provider Name | BENSON GEORGE MUNYAN III PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 3564 AVALON PARK E BLVD STE 1 IPMB 3039
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City | ORLANDO
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State | FL
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Zip | 32828-3282
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Country | US
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Telephone | 321-754-9099
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Fax |
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Provider Business Mailing Address
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Address Line | 11800 MEADOW BRANCH DR APT 417
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City | ORLANDO
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State | FL
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Zip | 32825-5055
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Country | US
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Telephone | 435-760-5789
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-005031
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY10498
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License Number State | FL
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