Basic Information
| Provider Information | |||||||||
| NPI: | 1417978859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENEDICT | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 634927 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452630042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136999240 | ||||||||
| FaxNumber: | 5136818959 | ||||||||
| Practice Location | |||||||||
| Address1: | 7105 HAMILTON AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452315218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136999240 | ||||||||
| FaxNumber: | 5136818959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 03/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | I-0004473 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | P00307274 | 01 | RR MEDICARE | OTHER |