Organization
BEN1818LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALEXANDRA BENYAMINOV LCSW-C (PSYCHOTHERAPIST)
(718) 640-5668
Entity
Organization
Contact information
Practice address
2700 WILLOW GLEN DR, BALTIMORE, MD 21209-3103
(718) 640-5668
Mailing address
2700 WILLOW GLEN DR, BALTIMORE, MD 21209-3103
(718) 640-5668
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
17516
MD
251S00000X
Community/Behavioral Health Agency
Primary
17516
MD
Other
Enumeration date
01/12/2016
Last updated
01/12/2016
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