Provider Demographics
NPI:1205801818
Name:BENEDETTO, EUGENE A (MA)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:A
Last Name:BENEDETTO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1021103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist