Basic Information
| Provider Information | |||||||||
| NPI: | 1881158046 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR. BENSFIELD, PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2428 BURR OAK AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH RIVERSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605461513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089065478 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2428 BURR OAK AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH RIVERSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605461513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089065478 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2019 | ||||||||
| LastUpdateDate: | 01/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | BENSFIELD | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CLINICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 7089065478 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.