Provider Demographics
NPI:1861926222
Name:BENJAMIN, THOMAS (MS, BCBA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MS, BCBA
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 7195
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-7195
Mailing Address - Country:US
Mailing Address - Phone:603-566-7648
Mailing Address - Fax:
Practice Address - Street 1:109 HAWTHORNE VILLAGE RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-2277
Practice Address - Country:US
Practice Address - Phone:603-566-7648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst