Individual
DR. BENJAMIN MICHAEL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1400 GRAND AVENUE, NEWPORT, KY 41071
(859) 301-5901
(859) 301-5940
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 301-5901
(859) 301-5940
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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