Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 31405 | CA |
Y | 103T00000X | Psychologist | 31405 | CA |
N | 103G00000X | Clinical Psychologist | 020980 | NY |
N | 103TC0700X | Clinical Psychologist | 020980 | NY |
NPI | 1013485390 |
---|---|
Provider Name | Dr. Catherine Benedict |
First Address | Palo Alto, CA 94304-1419 |
Second Address | Palo Alto, CA 94304-1419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2018 |
Last Update Date | 02/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020980 | NEW YORK STATE PSYCHOLOGY LICENSE (01) | NY |