Provider Demographics
NPI:1619961547
Name:BENEDICK, JAMES M (LCSW, EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:BENEDICK
Suffix:
Gender:M
Credentials:LCSW, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 N LOCKWOOD RIDGE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-3312
Mailing Address - Country:US
Mailing Address - Phone:941-358-0234
Mailing Address - Fax:941-355-3694
Practice Address - Street 1:5104 N LOCKWOOD RIDGE RD
Practice Address - Street 2:STE 105
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-3312
Practice Address - Country:US
Practice Address - Phone:941-358-0234
Practice Address - Fax:941-355-4694
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW24511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3636Medicare ID - Type UnspecifiedPROVIDER ID