Provider Demographics
NPI:1871608547
Name:BENEDETTO, CHERYL E (LPCC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:E
Last Name:BENEDETTO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 RED LEAF DR S APT 213
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-3023
Mailing Address - Country:US
Mailing Address - Phone:505-269-2988
Mailing Address - Fax:
Practice Address - Street 1:5775 RED LEAF DR S APT 213
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-3023
Practice Address - Country:US
Practice Address - Phone:505-269-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0017154101YP2500X
ORC8673101YP2500X
NMCCMH0118581101YM0800X, 101YP2500X
CO0017154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMedicare ID - Type Unspecified