=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366512360
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZOE BRADLEY-BENOIT PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 GREEN HILL RD
-----------------------------------------------------
City | SEBASTOPOL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95472-9735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-971-8091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 GREEN HILL RD
-----------------------------------------------------
City | SEBASTOPOL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95472-9735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-971-8091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY24678
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------