Provider Demographics
NPI:1154677086
Name:BENEDETTO, LAURA ANNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:BENEDETTO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 OVERLOOK CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9352
Mailing Address - Country:US
Mailing Address - Phone:631-849-3637
Mailing Address - Fax:
Practice Address - Street 1:5 OVERLOOK CT
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9352
Practice Address - Country:US
Practice Address - Phone:631-849-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency