Provider Demographics
NPI:1043471709
Name:DELVECCHIO, JENNIFER SUZANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:DELVECCHIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6817 SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1421
Mailing Address - Country:US
Mailing Address - Phone:215-910-1170
Mailing Address - Fax:845-485-4113
Practice Address - Street 1:6817 SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1421
Practice Address - Country:US
Practice Address - Phone:215-910-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0176661041C0700X
NY076774-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2945762OtherCIGNA
NY9957424OtherAETNA PROVIDER
NY11653356OtherEMPIRE BC/BS
NY02855585Medicaid
NY02855585Medicaid