Provider Demographics
NPI:1366106833
Name:MACDONALD, BENJAMIN LYLE (LCPC-C)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LYLE
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:439 US ROUTE 1 STE A
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1638
Mailing Address - Country:US
Mailing Address - Phone:207-520-5771
Mailing Address - Fax:207-520-5788
Practice Address - Street 1:3 NORMAND AVE APT A
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3214
Practice Address - Country:US
Practice Address - Phone:207-303-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7193101YP2500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional