Provider Demographics
NPI:1578616439
Name:BENEDETTO, ALICIA (PHD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BENEDETTO
Suffix:
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:PO BOX 11921
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29211-1921
Mailing Address - Country:US
Mailing Address - Phone:803-898-1474
Mailing Address - Fax:803-898-1471
Practice Address - Street 1:2100 BULL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2104
Practice Address - Country:US
Practice Address - Phone:803-898-1474
Practice Address - Fax:803-898-1471
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC974103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical