MEDICARE: ROBERT DAVID BENACCI LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC001117	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1410073	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1265564181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT DAVID BENACCI LPC

Provider Business Mailing Address
First Line	:	2520 HAMPTON RD
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16502-2068
Country	:	US
Telephone Number	:	814-456-2457
Fax Number	:	814-456-7679

Provider Business Practice Location Address
First Line	:	2520 HAMPTON RD
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16502-2068
Country	:	US
Telephone Number	:	814-456-2457
Fax Number	:	814-456-7679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	10/21/2014

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