Provider Demographics
NPI:1952420523
Name:BENEDICT, NICOLE D (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5921
Mailing Address - Country:US
Mailing Address - Phone:954-560-2082
Mailing Address - Fax:954-958-1620
Practice Address - Street 1:7501 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-5921
Practice Address - Country:US
Practice Address - Phone:954-560-2082
Practice Address - Fax:954-958-1620
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2046106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765824900Medicaid