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NPI Code Detail

MEDICARE: BENJAMIN HINDLE HAZEN LPC

MEDICARE: BENJAMIN HINDLE HAZEN LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorPC010952PA

General Provider Information

NPI Number : 1003465048
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN HINDLE HAZEN LPC
Provider Business Mailing Address
First Line : 1635 CATHARINE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19146-2036
Country : US
Telephone Number : 267-979-5930
Fax Number :
Provider Business Practice Location Address
First Line : 7811 GERMANTOWN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19118-3526
Country : US
Telephone Number : 267-625-2552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2019
Last Update Date : 09/18/2019

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