Provider Demographics
NPI:1992701916
Name:MEYERS, MARK BENJAMIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:BENJAMIN
Last Name:MEYERS
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 1:751 92ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2432
Mailing Address - Country:US
Mailing Address - Phone:239-213-0051
Mailing Address - Fax:
Practice Address - Street 1:751 92ND N AVE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2432
Practice Address - Country:US
Practice Address - Phone:239-213-0052
Practice Address - Fax:239-352-0737
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7046103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7266Medicare ID - Type Unspecified