Provider Demographics
NPI:1801592027
Name:DIBENEDETTO, KATELIN ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:KATELIN
Middle Name:ANNE
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1878 MARLTON PIKE E STE 5
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2090
Mailing Address - Country:US
Mailing Address - Phone:856-375-2440
Mailing Address - Fax:
Practice Address - Street 1:1878 ROUTE 70 E STE 5
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2090
Practice Address - Country:US
Practice Address - Phone:856-375-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC061611001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical