Provider Demographics
NPI:1619122314
Name:BENEDICK, JERED DANE (LCSW)
Entity Type:Individual
Prefix:
First Name:JERED
Middle Name:DANE
Last Name:BENEDICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6821
Mailing Address - Country:US
Mailing Address - Phone:877-800-5722
Mailing Address - Fax:512-869-2940
Practice Address - Street 1:775 INDIAN TRL
Practice Address - Street 2:STE. 200
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:254-698-3247
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX404081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical