Provider Demographics
NPI:1851994313
Name:DR DIBENEDETTO PSYCHOLOGY GROUP LLC
Entity Type:Organization
Organization Name:DR DIBENEDETTO PSYCHOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-716-6117
Mailing Address - Street 1:87 MAPLE AVENUE #2
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:917-716-6117
Mailing Address - Fax:732-647-1286
Practice Address - Street 1:87 MAPLE AVENUE #2
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:917-716-6117
Practice Address - Fax:732-647-1286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty