Provider Demographics
NPI:1306005475
Name:BENEDICT, JUDITH A (MS, EDS)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:A
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:MS, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1118
Mailing Address - Country:US
Mailing Address - Phone:203-525-0535
Mailing Address - Fax:860-229-5433
Practice Address - Street 1:222 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-1118
Practice Address - Country:US
Practice Address - Phone:203-525-0535
Practice Address - Fax:860-229-5433
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist