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General NPI Number Information
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NPI Number | 1215338223
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Entity Type | Individual
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Provider Name | BENJAMIN ADAMS PAUW LMFT
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Gender | Male
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 2712 TELEGRAPH AVE
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City | BERKELEY
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State | CA
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Zip | 94705-1117
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Country | US
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Telephone | 510-548-8283
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Fax |
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Provider Business Mailing Address
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Address Line | 2342 SHATTUCK AVE # 119
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City | BERKELEY
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State | CA
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Zip | 94704-1517
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMFT126089
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License Number State | CA
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