Provider Demographics
NPI:1033277496
Name:DIBENEDETTO, ENZA MARIA (MSMA)
Entity Type:Individual
Prefix:MS
First Name:ENZA
Middle Name:MARIA
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:MSMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 209TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1462
Mailing Address - Country:US
Mailing Address - Phone:718-352-5271
Mailing Address - Fax:
Practice Address - Street 1:104-70 QUEENS BOULEVARD SUITE 200
Practice Address - Street 2:BLEULER PSYCHOTHERAPY CENTER
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:10375
Practice Address - Country:US
Practice Address - Phone:718-275-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health