Provider Demographics
NPI:1447466487
Name:BENJAMIN, LYNN ROSE (MED)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ROSE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MAYO PL
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1228
Mailing Address - Country:US
Mailing Address - Phone:215-646-7932
Mailing Address - Fax:215-643-6766
Practice Address - Street 1:12 MAYO PL
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1228
Practice Address - Country:US
Practice Address - Phone:215-646-7932
Practice Address - Fax:215-643-6766
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000325106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMF000325OtherMARR&FMLYTHRPIST LICENSE