Healthcare Provider Details

I. General information

NPI: 1841800331
Provider Name (Legal Business Name): BENEDETTE THREET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SPRUCE ST
RIVERSIDE CA
92507-7402
US

IV. Provider business mailing address

11357 CHANTRY ST
FONTANA CA
92337-0872
US

V. Phone/Fax

Practice location:
  • Phone: 760-815-7772
  • Fax:
Mailing address:
  • Phone: 909-915-0922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: