Provider Demographics
NPI:1104237288
Name:HOUCHEN, BENJAMIN (MA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HOUCHEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SAN REMO DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6385
Mailing Address - Country:US
Mailing Address - Phone:802-658-9440
Mailing Address - Fax:
Practice Address - Street 1:75 SAN REMO DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6385
Practice Address - Country:US
Practice Address - Phone:802-658-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health