Provider Demographics
NPI:1194801928
Name:BENANDER, MARK K (PHD, MS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:K
Last Name:BENANDER
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Gender:M
Credentials:PHD, MS
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Mailing Address - Street 1:300 STAFFORD ST
Mailing Address - Street 2:SUITE 254 - MEDICAL PSYCHIATRY
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3581
Mailing Address - Country:US
Mailing Address - Phone:413-748-7010
Mailing Address - Fax:413-748-7011
Practice Address - Street 1:300 STAFFORD ST
Practice Address - Street 2:SUITE 254 - MEDICAL PSYCHIATRY
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3581
Practice Address - Country:US
Practice Address - Phone:413-748-7010
Practice Address - Fax:413-748-7011
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA7373103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical