Provider Demographics
NPI:1447996756
Name:STAINBROOK, BENJAMIN LEE
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEE
Last Name:STAINBROOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5644
Mailing Address - Country:US
Mailing Address - Phone:319-272-8922
Mailing Address - Fax:319-272-8929
Practice Address - Street 1:2750 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5644
Practice Address - Country:US
Practice Address - Phone:319-272-8922
Practice Address - Fax:319-272-8929
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health