MEDICARE: MR. MUSTAPHA BENSOUDA LMSW

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	103TB0200X	Cognitive & Behavioral Psychologist	124658-01	NY

General Provider Information

NPI Number	:	1730978958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MUSTAPHA BENSOUDA LMSW

Provider Business Mailing Address
First Line	:	1239 BOSTON RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-3614
Country	:	US
Telephone Number	:	646-410-1426
Fax Number	:

Provider Business Practice Location Address
First Line	:	1239 BOSTON RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-3614
Country	:	US
Telephone Number	:	551-751-0065
Fax Number	:

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

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	05/05/2025

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