Provider Demographics
NPI:1417978859
Name:BENEDICT, DEBORAH A (LISW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 634927
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0042
Mailing Address - Country:US
Mailing Address - Phone:513-699-9240
Mailing Address - Fax:513-681-8959
Practice Address - Street 1:7105 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-5218
Practice Address - Country:US
Practice Address - Phone:513-699-9240
Practice Address - Fax:513-681-8959
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0004473104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00307274OtherRR MEDICARE
P00307274OtherRR MEDICARE
OHSW29752Medicare PIN