Provider Demographics
NPI:1548547656
Name:BENEDICT, REBECCA RENEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:RENEE
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:RENEE
Other - Last Name:RONGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2519 LYNN DR
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2201
Mailing Address - Country:US
Mailing Address - Phone:510-375-5875
Mailing Address - Fax:
Practice Address - Street 1:1600 CALIFORNIA DRIVE
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95696
Practice Address - Country:US
Practice Address - Phone:707-448-6841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23679103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical