Provider Demographics
NPI:1730978958
Name:BENSOUDA, MUSTAPHA (LMSW)
Entity type:Individual
Prefix:MR
First Name:MUSTAPHA
Middle Name:
Last Name:BENSOUDA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3614
Mailing Address - Country:US
Mailing Address - Phone:646-410-1426
Mailing Address - Fax:
Practice Address - Street 1:1239 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3614
Practice Address - Country:US
Practice Address - Phone:551-751-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124658-01103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral