Provider Demographics
NPI:1497763502
Name:BENJAMIN, JOHN ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 CANNON RD
Mailing Address - Street 2:SUITE 2-B, #624
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4980
Mailing Address - Country:US
Mailing Address - Phone:951-315-5538
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL, CAMP PENDLETON
Practice Address - Street 2:MENTAL HEALTH CLINIC
Practice Address - City:CAMP PENDLETON, CA
Practice Address - State:CA
Practice Address - Zip Code:92055-5191
Practice Address - Country:US
Practice Address - Phone:760-725-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 06019103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist