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General NPI Number Information
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NPI Number | 1366106833
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Entity Type | Individual
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Provider Name | BENJAMIN LYLE MACDONALD LCPC-C
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Gender | Male
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Dates
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Enumeration Date | 10/29/2021
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 3 NORMAND AVE APT A
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City | SANFORD
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State | ME
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Zip | 04073-3214
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Country | US
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Telephone | 207-303-2509
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Fax |
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Provider Business Mailing Address
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Address Line | 439 US ROUTE 1 STE A
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City | YORK
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State | ME
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Zip | 03909-1638
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Country | US
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Telephone | 207-520-5771
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Fax | 207-520-5788
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | XL7193
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License Number State | ME
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