Provider Demographics
NPI:1356081731
Name:BENEDICO, ISABEL B
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:B
Last Name:BENEDICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 LUWAL DR
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1333
Mailing Address - Country:US
Mailing Address - Phone:561-475-7015
Mailing Address - Fax:
Practice Address - Street 1:6801 LAKE WORTH RD STE 322
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2966
Practice Address - Country:US
Practice Address - Phone:561-771-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-207369106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician