MEDICARE: MRS. DEIRDRE ANNE BENJAMIN LPCC

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
1	104100000X	Social Worker
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1447462866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEIRDRE ANNE BENJAMIN LPCC

Provider Business Mailing Address
First Line	:	765 STARGATE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-3843
Country	:	US
Telephone Number	:	719-474-9077
Fax Number	:	719-445-2216

Provider Business Practice Location Address
First Line	:	3055 AUSTIN BLUFFS PKWY STE C
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5758
Country	:	US
Telephone Number	:	719-327-2006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2007
Last Update Date	:	03/17/2018

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