Provider Demographics
NPI:1538836879
Name:ROWE, BENJAMIN (LCSW)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:ROWE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 JAMES ST # 1115
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2840
Mailing Address - Country:US
Mailing Address - Phone:315-800-9763
Mailing Address - Fax:
Practice Address - Street 1:2363 JAMES ST # 1115
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2840
Practice Address - Country:US
Practice Address - Phone:315-800-9763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085359-01104100000X
4244775171M00000X
DEQ1-00017431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator