Individual provider Active NPI

Johanna De Benedetto, LPC

  • Professional Counselor
  • Princeton Junction, NJ
National Provider Identifier
1639780307
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
37PC01077600 Issued in NJ
Practice address
231 Clarksville Rd Ste 4a
Princeton Junction, NJ 08550-5300
Phone
(732) 982-2888
Fax
(847) 859-5885
NPI assigned
Aug 14, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 37PC01077600 NJ Primary

Addresses

Primary practice location

231 Clarksville Rd Ste 4a
Princeton Junction, NJ 08550-5300

Mailing address

175 E Hawthorn Pkwy Ste 235
Vernon Hills, IL 60061-1454
Phone (847) 868-3435

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241209001658 NJ Practitioner - Mental Health Counselor 5092241455 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
New Jersey Behavioral Health PCGroup PAC ID 4284001025, 127 clinicians

Practice addresses (Care Compare)

10000 Midlantic Dr
Suite 101E
Mount Laurel, NJ 08054-1504
Phone (732) 982-2888

88 Princeton Hightstown Rd
Suite 202
Princeton Junction, NJ 08550-1100
Phone (732) 982-2888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
New Jersey Behavioral Health P.C CurrentSince Nov 25, 2024 Accepting new patients
PHC of Buffalo Grove Clinical Psychology CurrentSince Aug 23, 2020 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

175 E Hawthorne Pkwy
Ste 235
Vernon Hills, IL 60061
Phone (847) 865-4125

10000 Midlantic Dr
Ste 101E
Mount Laurel, NJ 08054
Phone (855) 760-2933

231 Clarksville Rd
Ste 4A
Princeton Junction, NJ 08550
Phone (329) 822-8887

88 Princeton Hightstown Rd
Ste 202
West Windsor, NJ 08550
Phone (609) 497-4900

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.johannadebenedetto@148376.advancedmd-direct.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1639780307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E HAWTHORN PKWY STE 235",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611454",
            "telephone_number": "847-868-3435",
            "fax_number": "847-859-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 CLARKSVILLE RD STE 4A",
            "city": "PRINCETON JUNCTION",
            "state": "NJ",
            "postal_code": "085505300",
            "telephone_number": "732-982-2888",
            "fax_number": "847-859-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE BENEDETTO",
        "first_name": "JOHANNA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-14",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC01077600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton Junction, NJ

Sources for this page

Verify at the official NPI Registry.