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Provider Information for 1114463643


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Mr. MARTIN BENTON PRICE M.S., LCPC


Sex: Male

NPI: 1114463643
Last Updated: 2019-01-17
Certification Date:

Details

NameValue
NPI1114463643
Enumeration Date2017-01-08
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 22 STANFORD RD
HAGERSTOWN, MD 21742-4517
United States

Phone: 301-660-1662 | Fax:
 
Primary Practice Address 1459 POTOMAC AVE
HAGERSTOWN, MD 21742-3315
United States

Phone: 240-513-4551 | Fax:410-848-5629
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDMD306804800
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalMDLC7553