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General NPI Number Information
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NPI Number | 1588999536
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Entity Type | Individual
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Provider Name | BENJAMIN JAMES HARGREAVES PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 07/12/2016
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Provider Practice Location Address
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Address Line | 1114 W DIXIE AVE
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City | LEESBURG
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State | FL
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Zip | 34748-6312
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Country | US
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Telephone | 218-230-4071
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Fax |
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Provider Business Mailing Address
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Address Line | 446 SAUVIGNON WAY
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City | GROVELAND
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State | FL
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Zip | 34736-3646
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Country | US
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Telephone | 218-230-4071
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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 | HAR829785
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY 9583
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License Number State | FL
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