=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528284098
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA ROSEANN BENSON LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 341 WYOMING AVE SUITE #3
-----------------------------------------------------
City | WEST PITTSTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-883-9020
-----------------------------------------------------
Fax | 570-602-7754
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 MULLEN ST
-----------------------------------------------------
City | PITTSTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-602-7753
-----------------------------------------------------
Fax | 570-602-7754
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC002441
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------