Basic Information
| Provider Information | |||||||||
| NPI: | 1376536961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DARBY | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 ROCKWOOD LN | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417019415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064365761 | ||||||||
| FaxNumber: | 6064365797 | ||||||||
| Practice Location | |||||||||
| Address1: | 3770 HIGHWAY 15 S | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 413398674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066667591 | ||||||||
| FaxNumber: | 6064365797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 11/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0995 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.