Provider Demographics
NPI:1467930248
Name:DIBENEDETTO, AMANDA N (RBT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:N
Other - Last Name:ESQUILIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15245 PINE DR
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1531
Mailing Address - Country:US
Mailing Address - Phone:214-205-0400
Mailing Address - Fax:
Practice Address - Street 1:15245 PINE DR
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1531
Practice Address - Country:US
Practice Address - Phone:214-205-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-18-61919106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician