Individual
JESSICA R BENJAMIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TP0814X
Psychoanalysis Psychologist
Primary
000704
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000704
NEW YORK STATE BOARD OF CERTIFICATION
NY
Enumeration date
06/08/2017
Last updated
06/08/2017
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