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General NPI Number Information
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NPI Number | 1427389469
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Entity Type | Individual
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Provider Name | BENJAMIN SHUTS LICSW
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Gender | Male
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 6176 HIGHWAY 291 STE 203
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City | NINE MILE FALLS
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State | WA
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Zip | 99026-9572
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Country | US
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Telephone | 415-444-6580
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Fax |
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Provider Business Mailing Address
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Address Line | 6176 HIGHWAY 291 STE 203
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City | NINE MILE FALLS
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State | WA
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Zip | 99026-9572
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Country | US
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Telephone | 415-444-6580
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 64886
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60797565
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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