1336662451 NPI number — MR. THOMAS JEFFREY BENN LMSW-CC

Table of content: MR. THOMAS JEFFREY BENN LMSW-CC (NPI 1336662451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336662451 NPI number — MR. THOMAS JEFFREY BENN LMSW-CC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENN
Provider First Name:
THOMAS
Provider Middle Name:
JEFFREY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMSW-CC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336662451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 DEVINE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEFIELD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-557-5513
Provider Business Mailing Address Fax Number:
207-549-7186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
276 WHITTEN ROAD
Provider Second Line Business Practice Location Address:
SUITE # 2
Provider Business Practice Location Address City Name:
HALLOWELL
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-624-6760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  MC16726 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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