Provider Demographics
NPI:1154539641
Name:BESEN, MARK BENNETT (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:BENNETT
Last Name:BESEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ROUTE 50
Mailing Address - Street 2:
Mailing Address - City:CORBIN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08270-9025
Mailing Address - Country:US
Mailing Address - Phone:609-628-2524
Mailing Address - Fax:
Practice Address - Street 1:128 CREST HAVEN ROAD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210
Practice Address - Country:US
Practice Address - Phone:609-463-0014
Practice Address - Fax:609-463-8671
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3898103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical