Provider Demographics
NPI:1548567589
Name:SALAZAR, BENJAMIN (MS, MFT, CADTP)
Entity type:Individual
Prefix:PROF
First Name:BENJAMIN
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:MS, MFT, CADTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4024
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91041-4024
Mailing Address - Country:US
Mailing Address - Phone:323-793-4944
Mailing Address - Fax:
Practice Address - Street 1:1545 N VERDUGO RD STE 203
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-2875
Practice Address - Country:US
Practice Address - Phone:323-793-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52049106H00000X
CA81042106H00000X
CA061333101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist