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Individual
DR. BENJAMIN MICHAEL ANDERSON
Active
Individual
DR. BENJAMIN MICHAEL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
128177
KY
103TC0700X
Clinical Psychologist
71007260
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100501510
—
KY
01
—
K237430
KY MEDICARE
KY
Enumeration date
04/19/2007
Last updated
03/08/2019
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