Healthcare Provider Details

I. General information

NPI: 1881084523
Provider Name (Legal Business Name): ELYSIA BENEDICT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE STE 161
WYNNEWOOD PA
19096-3427
US

IV. Provider business mailing address

105 RUTGERS AVE UNIT 420
SWARTHMORE PA
19081-2242
US

V. Phone/Fax

Practice location:
  • Phone: 484-284-1966
  • Fax: 610-595-9724
Mailing address:
  • Phone: 484-442-0141
  • Fax: 610-595-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS018174
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberB1-0001051
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberB1-0001051
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS018174
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: