Provider Demographics
NPI:1366512360
Name:BRADLEY-BENOIT, ZOE (PSYD)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:BRADLEY-BENOIT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9735
Mailing Address - Country:US
Mailing Address - Phone:415-971-8091
Mailing Address - Fax:
Practice Address - Street 1:1801 GREEN HILL RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-9735
Practice Address - Country:US
Practice Address - Phone:415-971-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24678103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical