Provider Demographics
NPI:1578160685
Name:BENIGSOHN, NANCY (LSAA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BENIGSOHN
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6404 JAGUAR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-1702
Mailing Address - Country:US
Mailing Address - Phone:505-819-8481
Mailing Address - Fax:
Practice Address - Street 1:BLUE JAY COUNSELING
Practice Address - Street 2:1850 CALLE MEDICO
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-570-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTL0213111101YM0800X
NMCTB-2024-0574101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health