Provider Demographics
NPI:1316708878
Name:GAJDORUS, BENJAMIN M (LCSW)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:GAJDORUS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10-42 MITCHELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903
Mailing Address - Country:US
Mailing Address - Phone:607-762-2533
Mailing Address - Fax:607-762-2001
Practice Address - Street 1:1 ELY PARK BLVD APT 58-6
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-1445
Practice Address - Country:US
Practice Address - Phone:607-242-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0908561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical