Provider Demographics
NPI:1588143184
Name:SPON, BENJAMIN PAUL (BA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:PAUL
Last Name:SPON
Suffix:
Gender:
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2359 KNOLLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1525
Mailing Address - Country:US
Mailing Address - Phone:162-601-4052
Mailing Address - Fax:330-632-8823
Practice Address - Street 1:108 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1724
Practice Address - Country:US
Practice Address - Phone:162-601-4052
Practice Address - Fax:330-632-8823
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician