Individual
DR. BENNY S WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
691 MASSACHUSSETS AVENUE, SUITE 10, ARLINGTON, MA 02479-1648
(617) 242-4228
Mailing address
691 MASSACHUSSETS AVENUE, SUITE 10, ARLINGTON, MA 02479-1648
(617) 242-4228
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6244
MA
103TB0200X
Cognitive & Behavioral Psychologist
6244
MA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
6244
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WO4947
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/10/2007
Last updated
11/25/2015
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