Individual
BENJAMIN SUPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
833 N PARK RD, WYOMISSING, PA 19610-1341
(610) 396-5094
Mailing address
624 BROWNSVILLE RD, READING, PA 19608-9728
(484) 331-8469
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MF001661
PA
Other
Enumeration date
09/27/2024
Last updated
09/27/2024
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