MEDICARE: BENJAMIN WAREHIME, LCSW LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1477204857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENJAMIN WAREHIME, LCSW LLC

Provider Business Mailing Address
First Line	:	311 REDMOND RD
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-1504
Country	:	US
Telephone Number	:	848-333-9587
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 MORRIS AVE STE 3
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1025
Country	:	US
Telephone Number	:	973-910-8300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BENJAMIN WAREHIME
Credential	:	LCSW
Telephone Number	:	848-333-9587

Provider Enumeration Date	:	01/17/2022
Last Update Date	:	01/17/2022

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