Provider Demographics
NPI:1164453676
Name:DEBENEDETTO, RICHARD PETER (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PETER
Last Name:DEBENEDETTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 S BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3429
Mailing Address - Country:US
Mailing Address - Phone:914-244-0755
Mailing Address - Fax:914-244-0754
Practice Address - Street 1:83 S BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3429
Practice Address - Country:US
Practice Address - Phone:914-244-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008548-1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV63561Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYR52575Medicare UPIN