Provider Demographics
NPI:1548450828
Name:BENJAMIN, JANET LORRAINE (LMFT PSYD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:LORRAINE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LMFT PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PLYMOUTH
Mailing Address - State:ID
Mailing Address - Zip Code:83655
Mailing Address - Country:US
Mailing Address - Phone:208-971-2474
Mailing Address - Fax:208-203-9158
Practice Address - Street 1:933 N. KINGS ROAD
Practice Address - Street 2:
Practice Address - City:NEW PLYMOUTH
Practice Address - State:ID
Practice Address - Zip Code:83687
Practice Address - Country:US
Practice Address - Phone:208-971-2474
Practice Address - Fax:208-203-9158
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47795106H00000X
ID5744106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist