1366106833 NPI number — MR. BENJAMIN LYLE MACDONALD LCPC-C

Table of content: MR. BENJAMIN LYLE MACDONALD LCPC-C (NPI 1366106833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366106833 NPI number — MR. BENJAMIN LYLE MACDONALD LCPC-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACDONALD
Provider First Name:
BENJAMIN
Provider Middle Name:
LYLE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCPC-C
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:
1366106833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
439 US ROUTE 1 STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
03909-1638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-520-5771
Provider Business Mailing Address Fax Number:
207-520-5788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 NORMAND AVE APT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04073-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-303-2509
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2021

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: 101YP2500X , with the licence number:  XL7193 , 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)





Copyright © 2007-2025 www.npivalidator.com