Basic Information
| Provider Information | |||||||||
| NPI: | 1235680273 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENZENBERG | ||||||||
| FirstName: | LAURENNE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 FORTUNE RD W | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109411625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4585008136 | ||||||||
| FaxNumber: | 8453433341 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 UNION ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109404906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455008136 | ||||||||
| FaxNumber: | 8453433341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2016 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | NY096332 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 090267 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.