Provider Demographics
NPI:1306883145
Name:BENSON, MARY ANN THERESA (LSW)
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:THERESA
Last Name:BENSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9113
Mailing Address - Country:US
Mailing Address - Phone:570-743-1054
Mailing Address - Fax:570-374-7529
Practice Address - Street 1:1800 MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1236
Practice Address - Country:US
Practice Address - Phone:570-524-9477
Practice Address - Fax:570-524-9492
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-013397-L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03268701OtherCAPITAL BLUE CROSS