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General NPI Number Information
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NPI Number | 1518808237
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Entity Type | Individual
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Provider Name | BENJAMIN JAMES DIYENNO LAC
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Gender | Male
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Dates
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Enumeration Date | 04/06/2026
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Last Update Date | 04/06/2026
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Provider Practice Location Address
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Address Line | 1387 CHEWS LANDING RD
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City | CLEMENTON
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State | NJ
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Zip | 08021-2760
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Country | US
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Telephone | 855-857-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 37 MOHAWK TRL
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City | MEDFORD LAKES
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State | NJ
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Zip | 08055-1526
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Country | US
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Telephone | 609-922-3827
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00946200
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License Number State | NJ
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