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General NPI Number Information
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NPI Number | 1336266444
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Entity Type | Individual
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Provider Name | CHRISTINE MARIE DIBENEDETTO PSY D
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 5237 SUMMERLIN COMMONS BLVD # F
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City | FORT MYERS
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State | FL
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Zip | 33907-2158
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Country | US
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Telephone | 239-357-2298
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Fax | 239-208-2639
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Provider Business Mailing Address
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Address Line | 11128 YELLOW POPLAR DR
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City | FORT MYERS
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State | FL
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Zip | 33913-8884
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Country | US
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Telephone | 239-357-2298
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Fax | 239-208-2639
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 16524
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 7887
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License Number State | FL
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