Provider Demographics
NPI:1194882522
Name:BENTON, BILLIE BYRON (LCSW)
Entity type:Individual
Prefix:MR
First Name:BILLIE
Middle Name:BYRON
Last Name:BENTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:BYRON
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:MAYSLANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-0093
Mailing Address - Country:US
Mailing Address - Phone:609-625-2062
Mailing Address - Fax:609-625-2970
Practice Address - Street 1:707 WHITE HORSE PIKE
Practice Address - Street 2:SUITE A3
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201
Practice Address - Country:US
Practice Address - Phone:609-383-3330
Practice Address - Fax:609-383-3301
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001863001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
816164Medicare ID - Type Unspecified