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General NPI Number Information
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NPI Number | 1235876194
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Entity Type | Individual
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Provider Name | MICHAEL BENSON METH PSYD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2022
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 512 CANAL ST
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7012
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Country | US
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Telephone | 954-817-3036
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 WESTGATE CIR
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2093
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Country | US
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Telephone | 954-817-3036
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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 | 11479
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License Number State | FL
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