Clark, Benjamin

Clark, Benjamin is an individual health care provider with primary practice located at 1727 N Ocean Ave , Medford NY 11763-2649. He recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as his primary health care specialty. Clark, Benjamin can be contacted via phone (631) 654-1919.

Contact Information

Primary practice address
1727 N Ocean Ave Medford NY 11763-2649
Phone: (631) 654-1919
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X 078914-1 New York

Profile Details

NPI number 1376863696
LBN Legal business name Clark, Benjamin
Credentials LMSW
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2010
Last updated Jun 9th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376863696 NPPES
New York Other 078914-1 LICENSE

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