Individual
BENJAMIN FENNIMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1787 STATE ST, SALEM, OR 97301-4342
(503) 566-2132
Mailing address
2860 WINTER ST SE, SALEM, OR 97302-3155
(503) 428-2948
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
L11039
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255964730
—
OR
05
—
1417567983
—
OR
Enumeration date
09/03/2014
Last updated
07/05/2023
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