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General NPI Number Information
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NPI Number | 1942666524
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Entity Type | Organization
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Legal Business Name | BEN1818LLC
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 2700 WILLOW GLEN DR
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City | BALTIMORE
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State | MD
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Zip | 21209-3103
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Country | US
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Telephone | 718-640-5668
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 WILLOW GLEN DR
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City | BALTIMORE
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State | MD
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Zip | 21209-3103
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Country | US
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Telephone | 718-640-5668
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. ALEXANDRA BENYAMINOV
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Credential | LCSW-C
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Telephone | 718-640-5668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 17516
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 17516
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License Number State | MD
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