Provider Demographics
NPI:1124753157
Name:BENJAMIN, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-3401
Mailing Address - Country:US
Mailing Address - Phone:908-202-9046
Mailing Address - Fax:
Practice Address - Street 1:125 FRONT ST
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-3401
Practice Address - Country:US
Practice Address - Phone:908-202-9046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health