Holly A Benedetto, LPC
Individual provider Active NPI Professional Counselor · Bridgeport, CT
NPI 1346790599 · NPPES record last updated Oct 12, 2016
Key facts
- NPI
- 1346790599
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 003041 (CT)
- Practice address
- 475 Clinton Ave
Bridgeport, CT 06605-1700 - Phone
- (203) 368-4291
- Fax
- (203) 368-9167
- NPI assigned
- Oct 12, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003041 | CT | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 003041 | CT | Yes |
Addresses
Primary practice location
475 Clinton Ave
Bridgeport, CT 06605-1700
Mailing address
475 Clinton Ave
Bridgeport, CT 06605-1700
Phone (203) 368-4291
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004069985 | Medicaid | CT |
Other providers in Bridgeport, CT
- Laura Belland
- Matthew A Bellard
- Steven Lewis Belmont
- Glenn John Buenviaje Beloso
- Jailawu Ben
- Jaimee A Benes Dettmer
- Elvina Benjamin
- Marissa Benvenuto
- James Patrick Berg
- Deborah Berger
All providers in Bridgeport, CT · Professional Counselor in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.