Provider Demographics
NPI:1366455149
Name:DIBENNARDO, FRANK RICHARD I (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:RICHARD
Last Name:DIBENNARDO
Suffix:I
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CROYDEN RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4608
Mailing Address - Country:US
Mailing Address - Phone:516-873-7661
Mailing Address - Fax:
Practice Address - Street 1:11050 71ST RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4969
Practice Address - Country:US
Practice Address - Phone:718-263-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004182-1103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04900Medicare ID - Type UnspecifiedPROVIDER NUMBER