Provider Demographics
NPI:1427412741
Name:R. BENJAMIN BEHAVIORAL CONSULTING
Entity type:Organization
Organization Name:R. BENJAMIN BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:TREFFERT
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:262-880-8405
Mailing Address - Street 1:233 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1919
Mailing Address - Country:US
Mailing Address - Phone:262-989-7748
Mailing Address - Fax:
Practice Address - Street 1:233 OHIO ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1919
Practice Address - Country:US
Practice Address - Phone:262-989-7748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-21385251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management