Healthcare Provider Details

I. General information

NPI: 1750820809
Provider Name (Legal Business Name): AMY BENEDETTI-ASHLOCK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOWMAN DR SUITE E340
VOORHEES NJ
08043-9623
US

IV. Provider business mailing address

200 BOWMAN DR SUITE E340
VOORHEES NJ
08043-9623
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-7586
  • Fax: 856-247-7575
Mailing address:
  • Phone: 856-247-7586
  • Fax: 856-247-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05721500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: