MEDICARE: DR. JAMES BENTON

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	103T00000X	Psychologist	048.0111577	VT
2	103TC0700X	Clinical Psychologist	048.0111577	VT

General Provider Information

NPI Number	:	1881073187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES BENTON

Provider Business Mailing Address
First Line	:	63 PICCADILLY RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-1549
Country	:	US
Telephone Number	:	516-732-0960
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 PICCADILLY RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-1549
Country	:	US
Telephone Number	:	516-732-0960
Fax Number	:

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

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	02/05/2026

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Directions to “ DR. JAMES BENTON ” Practice Location

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