Provider Demographics
NPI:1104525658
Name:RACHEL BENJAMIN PSYD LICENSED PSYCHOLOGIST PLLC
Entity type:Organization
Organization Name:RACHEL BENJAMIN PSYD LICENSED PSYCHOLOGIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP, PLLC
Authorized Official - Phone:248-952-8116
Mailing Address - Street 1:15900 W 10 MILE RD STE 211
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2079
Mailing Address - Country:US
Mailing Address - Phone:248-952-8116
Mailing Address - Fax:
Practice Address - Street 1:17138 ALTA VISTA DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1981
Practice Address - Country:US
Practice Address - Phone:248-952-8116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health