Provider Demographics
NPI:1467554634
Name:BENEDICT, GEORGE EDWARD (MA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EDWARD
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3595 POST RD
Mailing Address - Street 2:APT # 16105
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7078
Mailing Address - Country:US
Mailing Address - Phone:401-737-5404
Mailing Address - Fax:
Practice Address - Street 1:PROVIDENCE VAMC
Practice Address - Street 2:830 CHALKSTONE AVENUE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4799
Practice Address - Country:US
Practice Address - Phone:401-271-7300
Practice Address - Fax:401-457-1401
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)