Active NPI
Rachel Benjamin, PSYD, LP
- Clinical Psychologist
- Southfield, MI
National Provider Identifier
1073229027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301019253
- Practice address
- 17138 Alta Vista Dr
Southfield, MI 48075-1981 - Phone
- (845) 274-2268
- NPI assigned
- Jan 24, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301019253 | MI | Primary |
Addresses
Primary practice location
17138 Alta Vista Dr
Southfield, MI 48075-1981
Mailing address
15900 W 10 Mile Rd Ste 211
Southfield, MI 48075-2079
Phone (845) 274-2268
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6301019253 | Other | MI | PSYCHOLOGIST LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677110400000",
"number": "1073229027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15900 W 10 MILE RD STE 211",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480752079",
"telephone_number": "845-274-2268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17138 ALTA VISTA DR",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480751981",
"telephone_number": "845-274-2268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENJAMIN",
"first_name": "RACHEL",
"name_prefix": "Dr.",
"credential": "PSYD, LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-01-24",
"last_updated": "2023-02-23",
"certification_date": "2023-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301019253",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGIST LICENSE",
"identifier": "6301019253",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.