Provider Demographics
NPI:1619041647
Name:BENEDICK, DEBRA ANN (MS)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:BENEDICK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 PENORA ST
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4505
Mailing Address - Country:US
Mailing Address - Phone:716-683-5769
Mailing Address - Fax:716-681-5300
Practice Address - Street 1:2470 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4751
Practice Address - Country:US
Practice Address - Phone:716-681-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18001123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health