=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952420523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE D BENEDICT M.S., L.M.F.T
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7501 NW 12TH ST
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33313-5921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-560-2082
-----------------------------------------------------
Fax | 954-958-1620
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7501 NW 12TH ST
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33313-5921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-560-2082
-----------------------------------------------------
Fax | 954-958-1620
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT2046
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------