Provider Demographics
NPI:1588800098
Name:THERESA A BENEDICT LLC
Entity Type:Organization
Organization Name:THERESA A BENEDICT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CROCE BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:941-830-0165
Mailing Address - Street 1:2254 OLEADA CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-9074
Mailing Address - Country:US
Mailing Address - Phone:941-830-0165
Mailing Address - Fax:
Practice Address - Street 1:329 NOKOMIS AVE S STE H
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2418
Practice Address - Country:US
Practice Address - Phone:941-830-0165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW76651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty