Provider Demographics
NPI:1871614990
Name:BENSON WEINBERG CLINICAL ASSOCIATES PC
Entity type:Organization
Organization Name:BENSON WEINBERG CLINICAL ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT LIC CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-565-2609
Mailing Address - Street 1:1031 S WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1817
Mailing Address - Country:US
Mailing Address - Phone:708-383-1871
Mailing Address - Fax:
Practice Address - Street 1:233 E WACKER DRIVE
Practice Address - Street 2:SUITE #4307
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5117
Practice Address - Country:US
Practice Address - Phone:312-565-2609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL397260Medicare ID - Type UnspecifiedCAROLE S BENSON PHD