Individual
BENJAMIN STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
5130 E MAIN ST STE 2, BATAVIA, NY 14020-3444
(585) 344-1421
Mailing address
5130 E MAIN ST STE 2, BATAVIA, NY 14020-3444
(585) 344-1421
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
111925-01
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
08/21/2020
Last updated
03/31/2021
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