Provider Demographics
NPI:1730131970
Name:EUGENE A BENEDETTO
Entity Type:Organization
Organization Name:EUGENE A BENEDETTO
Other - Org Name:BENEDETTO AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:MA- PSYCHOLOGIST
Authorized Official - Phone:440-526-0468
Mailing Address - Street 1:8227 BRECKSVILLE RD
Mailing Address - Street 2:104
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1370
Mailing Address - Country:US
Mailing Address - Phone:440-526-0468
Mailing Address - Fax:440-526-0454
Practice Address - Street 1:8227 BRECKSVILLE RD
Practice Address - Street 2:104
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1370
Practice Address - Country:US
Practice Address - Phone:440-526-0468
Practice Address - Fax:440-526-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBE9279841Medicare PIN