Provider Demographics
NPI:1659116622
Name:BENEDETTO, ELAINA
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:BENEDETTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 RACHEL TER APT 24
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9351
Mailing Address - Country:US
Mailing Address - Phone:347-884-0539
Mailing Address - Fax:
Practice Address - Street 1:999 RIVERVIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1165
Practice Address - Country:US
Practice Address - Phone:551-276-8291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health