Provider Demographics
NPI:1134232994
Name:BENJAMIN, ADRIENNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3038
Mailing Address - Country:US
Mailing Address - Phone:860-667-9498
Mailing Address - Fax:860-667-2408
Practice Address - Street 1:1268 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3038
Practice Address - Country:US
Practice Address - Phone:860-667-9498
Practice Address - Fax:860-667-2408
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0026621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1015430OtherCIGNA
CT283967OtherMHN
CT140002662CT01OtherBLUE CROSS
CT163057OtherVALUE OPTIONS