Provider Demographics
NPI:1639601339
Name:BENEDETTI, MAGGIE (LMSW)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:BENEDETTI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:BURKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:9196 W EMERALD ST
Mailing Address - Street 2:STE. 135
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-0679
Mailing Address - Country:US
Mailing Address - Phone:208-323-4400
Mailing Address - Fax:
Practice Address - Street 1:9196 W EMERALD ST
Practice Address - Street 2:STE. 135
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-0679
Practice Address - Country:US
Practice Address - Phone:208-323-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID36310104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker