Provider Demographics
NPI:1144762485
Name:DIBENEDETTO, LEANN (LCSW)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 DELSEA DR S
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2621
Mailing Address - Country:US
Mailing Address - Phone:856-881-8689
Mailing Address - Fax:856-881-5508
Practice Address - Street 1:114 BLACKWOOD BARNSBORO RD
Practice Address - Street 2:BLACKWOOD BARNSBORO RD
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4200
Practice Address - Country:US
Practice Address - Phone:856-481-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056507001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical