Provider Demographics
NPI:1306252564
Name:MORSA, BENJAMIN ALEX
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALEX
Last Name:MORSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:ALEX
Other - Last Name:VAN AUKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3099 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2035
Mailing Address - Country:US
Mailing Address - Phone:510-423-8473
Mailing Address - Fax:
Practice Address - Street 1:5299 COLLEGE AVE STE C7
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-2809
Practice Address - Country:US
Practice Address - Phone:510-423-8473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103T00000X
CAPSY29349103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist