Provider Demographics
NPI:1720269830
Name:BENEDETTO AND ASSOCIATES
Entity Type:Organization
Organization Name:BENEDETTO AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
Mailing Address - Fax:
Practice Address - Street 1:20033 DETROIT RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2400
Practice Address - Country:US
Practice Address - Phone:440-526-0468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEDETTO AND ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-16
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9279842Medicare PIN