Basic Information
| Provider Information | |||||||||
| NPI: | 1588187058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMENDOLA | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 POPLAR RD | ||||||||
| Address2: | |||||||||
| City: | DEMAREST | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076271310 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 17-07 ROMAINE ST | ||||||||
| Address2: | |||||||||
| City: | FAIR LAWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074102150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012658200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2017 | ||||||||
| LastUpdateDate: | 07/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SL06076300 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.