MEDICARE: ASHLEY P BENSON, 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
1	1041C0700X	Clinical Social Worker	117410	MA

General Provider Information

NPI Number	:	1699210492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLEY P BENSON, LICSW

Provider Business Mailing Address
First Line	:	132 MASS MOCA WAY
Second Line	:
City	:	NORTH ADAMS
State	:	MA
Zip	:	01247-2446
Country	:	US
Telephone Number	:	413-464-5408
Fax Number	:	413-664-4660

Provider Business Practice Location Address
First Line	:	132 MASS MOCA WAY
Second Line	:
City	:	NORTH ADAMS
State	:	MA
Zip	:	01247-2446
Country	:	US
Telephone Number	:	413-464-5408
Fax Number	:	413-664-4660

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY P BENSON
Credential	:	LICSW
Telephone Number	:	413-464-5408

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	01/03/2017

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