Provider Demographics
NPI:1316978935
Name:BENOIT, LARRY JAMES (PHD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JAMES
Last Name:BENOIT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CAILLOUETT PL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-7807
Mailing Address - Country:US
Mailing Address - Phone:337-234-4912
Mailing Address - Fax:337-234-6064
Practice Address - Street 1:119 CAILLOUETT PL
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-7807
Practice Address - Country:US
Practice Address - Phone:337-234-4912
Practice Address - Fax:337-234-6064
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA541103G00000X, 103TA0400X, 103TC0700X, 103TF0200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S328Medicare ID - Type UnspecifiedPROVIDER