Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6087 | MA |
Y | 103TC0700X | Clinical Psychologist | 6087 | MA |
NPI | 1013028604 |
---|---|
Provider Name | Dr. Camille M Dibenedetto |
First Address | Cambridge, MA 02139 |
Second Address | Cambridge, MA 02139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |