Provider Demographics
NPI:1598597585
Name:WEINBECK, BENEDICT J III (MA)
Entity type:Individual
Prefix:
First Name:BENEDICT
Middle Name:J
Last Name:WEINBECK
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55356-0937
Mailing Address - Country:US
Mailing Address - Phone:952-456-1389
Mailing Address - Fax:
Practice Address - Street 1:4154 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:SPRING PARK
Practice Address - State:MN
Practice Address - Zip Code:55384-5606
Practice Address - Country:US
Practice Address - Phone:952-491-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health