Provider Demographics
NPI:1073548954
Name:BENEDETTI, BEVERLY A (APRN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:BENEDETTI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MAIN ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1469
Mailing Address - Country:US
Mailing Address - Phone:508-238-7766
Mailing Address - Fax:508-230-5089
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1468
Practice Address - Country:US
Practice Address - Phone:508-238-7766
Practice Address - Fax:508-230-5089
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA135768364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA410342OtherTUFTS HEALTH PLAN
MA245910OtherMAGELLAN
MA422938OtherPILGRIM
MAPN0582OtherBC BS OF MASSACHUSETTS
MANS0093Medicare ID - Type UnspecifiedMASSACHUSETTS MEDICARE
MA245910OtherMAGELLAN