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NPI Code Detail

MEDICARE: MICHAEL CHARLES BENJAMIN LICSW

MEDICARE: MICHAEL CHARLES BENJAMIN LICSW
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
11041C0700XClinical Social WorkerLCSW26297ID
21041C0700XClinical Social Worker20659MN

General Provider Information

NPI Number : 1457311789
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL CHARLES BENJAMIN LICSW
Provider Business Mailing Address
First Line : 5255 MEMBERS PKWY NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-8381
Country : US
Telephone Number : 507-218-3701
Fax Number :
Provider Business Practice Location Address
First Line : 5255 MEMBERS PKWY NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-8381
Country : US
Telephone Number : 507-218-3701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 10/09/2019

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