MEDICARE: ELYSIA BENEDICT PH.D.

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
1	103G00000X	Clinical Neuropsychologist	PS018174	PA
2	103TC0700X	Clinical Psychologist	B1-0001051	DE
3	103G00000X	Clinical Neuropsychologist	B1-0001051	DE
4	103TC0700X	Clinical Psychologist	PS018174	PA

General Provider Information

NPI Number	:	1881084523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELYSIA BENEDICT PH.D.

Provider Business Mailing Address
First Line	:	105 RUTGERS AVE UNIT 420
Second Line	:
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-2242
Country	:	US
Telephone Number	:	484-442-0141
Fax Number	:	610-595-9724

Provider Business Practice Location Address
First Line	:	100 E LANCASTER AVE STE 161
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3427
Country	:	US
Telephone Number	:	484-284-1966
Fax Number	:	610-595-9724

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	01/30/2026

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