Provider Demographics
NPI:1336266444
Name:DIBENEDETTO, CHRISTINE MARIE (PSY D)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11128 YELLOW POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8884
Mailing Address - Country:US
Mailing Address - Phone:239-357-2298
Mailing Address - Fax:239-208-2639
Practice Address - Street 1:5237 SUMMERLIN COMMONS BLVD # F
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2158
Practice Address - Country:US
Practice Address - Phone:239-357-2298
Practice Address - Fax:239-208-2639
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16524103T00000X
FLPY 7887103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist