Provider Demographics
NPI:1104982024
Name:BENOWITZ, MARTIN (EDD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:BENOWITZ
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2207
Mailing Address - Country:US
Mailing Address - Phone:978-534-1600
Mailing Address - Fax:
Practice Address - Street 1:292 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2207
Practice Address - Country:US
Practice Address - Phone:978-534-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1896103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA320818OtherHARVARD PILGRIM HC
MA716848OtherTUFTS HP
MAW02045OtherBCBS
MA1011290OtherBEACON HEALTH
MAW02045OtherBCBS