Healthcare Provider Details

I. General information

NPI: 1700061827
Provider Name (Legal Business Name): VICTORIA DEBENEDETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W CLINTON AVE
FRESNO CA
93705-3223
US

IV. Provider business mailing address

3427 N FRESNO ST
FRESNO CA
93726-6524
US

V. Phone/Fax

Practice location:
  • Phone: 559-274-0299
  • Fax:
Mailing address:
  • Phone: 559-264-6978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: