Individual provider Active NPI

Maria Dibenedetto, LAC

  • Mental Health Counselor
  • Glen Rock, NJ
National Provider Identifier
1861090573
Registry record updated Oct 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
37AC00476000 Issued in NJ
Practice address
65 Harristown Rd Ste 310
Glen Rock, NJ 07452-3356
Phone
(732) 982-2888
Fax
(847) 859-5885
NPI assigned
Oct 14, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 37AC00476000 NJ Primary

Addresses

Primary practice location

65 Harristown Rd Ste 310
Glen Rock, NJ 07452-3356

Mailing address

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

Other practice location 1

70 Hilltop Rd Ste 2350
Ramsey, NJ 07446-1161
Phone (732) 982-2888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
37AC00476000NJMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
New Jersey Behavioral Health P.C CurrentSince Feb 4, 2024 Accepting new patients
PHC of Buffalo Grove Clinical Psychology CurrentSince Oct 19, 2020 Accepting new patients

Locations

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

65 Harristown Rd
Ste 310
Glen Rock, NJ 07452

70 Hilltop Rd
Ste 2350
Ramsey, NJ 07446
Phone (201) 894-0003

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": "1602633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1861090573",
    "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": "65 HARRISTOWN RD STE 310",
            "city": "GLEN ROCK",
            "state": "NJ",
            "postal_code": "074523356",
            "telephone_number": "732-982-2888",
            "fax_number": "847-859-5885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "70 Hilltop Rd Ste 2350",
            "address_purpose": "LOCATION",
            "city": "Ramsey",
            "state": "NJ",
            "postal_code": "074461161",
            "country_code": "US",
            "telephone_number": "732-982-2888",
            "fax_number": "847-859-5885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIBENEDETTO",
        "first_name": "MARIA",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37AC00476000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Rock, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.