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General NPI Number Information
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NPI Number | 1588800098
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Entity Type | Organization
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Legal Business Name | THERESA A BENEDICT LLC
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 329 NOKOMIS AVE S STE H
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City | VENICE
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State | FL
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Zip | 34285-2418
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Country | US
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Telephone | 941-830-0165
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Fax |
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Provider Business Mailing Address
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Address Line | 2254 OLEADA CT
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City | ENGLEWOOD
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State | FL
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Zip | 34224-9074
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Country | US
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Telephone | 941-830-0165
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MS. THERESA ANN CROCE BENEDICT
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Credential | LCSW
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Telephone | 941-830-0165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW7665
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License Number State | FL
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