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NPI Code Detail

MEDICARE: KELLY DIBENEDETTO LMHC

MEDICARE: KELLY DIBENEDETTO LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1295067742
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY DIBENEDETTO LMHC
Provider Business Mailing Address
First Line : 90 HOMESTEAD AVE
Second Line :
City : WEYMOUTH
State : MA
Zip : 02188-2126
Country : US
Telephone Number : 781-724-8252
Fax Number :
Provider Business Practice Location Address
First Line : 1112 WASHINGTON ST STE 310
Second Line :
City : HANOVER
State : MA
Zip : 02339-1675
Country : US
Telephone Number : 781-757-2456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2010
Last Update Date : 07/09/2024

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