=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871614990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENSON WEINBERG CLINICAL ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 233 E WACKER DRIVE SUITE #4307
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60601-5117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-565-2609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1031 S WISCONSIN AVE
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60304-1817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-383-1871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT LIC CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. CAROLE S BENSON
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 312-565-2609
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------