Basic Information
| Provider Information | |||||||||
| NPI: | 1518368331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELGADO | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | MARCUS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1045 | ||||||||
| Address2: | |||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955181045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075729440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3750 ROHNERVILLE ROAD | ||||||||
| Address2: | |||||||||
| City: | FORTUNA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077256101 | ||||||||
| FaxNumber: | 7077252978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2014 | ||||||||
| LastUpdateDate: | 01/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | L6320 | OR | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LCSW87293 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | L6320 | OR | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.