Provider Demographics
NPI:1588999536
Name:HARGREAVES, BENJAMIN JAMES (PSYD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JAMES
Last Name:HARGREAVES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 SAUVIGNON WAY
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-3646
Mailing Address - Country:US
Mailing Address - Phone:218-230-4071
Mailing Address - Fax:
Practice Address - Street 1:1114 W DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6312
Practice Address - Country:US
Practice Address - Phone:218-230-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDHAR829785101YM0800X
FLPY 9583103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health