Provider Demographics
NPI:1043493414
Name:DEBENEDICTIS, JOAN ELIZABETH (BS IN EDUCATION)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:ELIZABETH
Last Name:DEBENEDICTIS
Suffix:
Gender:F
Credentials:BS IN EDUCATION
Other - Prefix:MISS
Other - First Name:JOAN
Other - Middle Name:ELIZABETH
Other - Last Name:HOSMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS IN EDUCATION
Mailing Address - Street 1:111 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1827
Mailing Address - Country:US
Mailing Address - Phone:978-921-1182
Mailing Address - Fax:978-921-2982
Practice Address - Street 1:111 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1827
Practice Address - Country:US
Practice Address - Phone:978-921-1182
Practice Address - Fax:978-921-2982
Is Sole Proprietor?:No
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist