Provider Demographics
NPI:1215218078
Name:DELMEDICO, ANTHONY ANDREW (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ANDREW
Last Name:DELMEDICO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PAVERSTONE DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4710
Mailing Address - Country:US
Mailing Address - Phone:919-623-8118
Mailing Address - Fax:
Practice Address - Street 1:901 PAVERSTONE DR
Practice Address - Street 2:SUITE 9
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4710
Practice Address - Country:US
Practice Address - Phone:919-623-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1490106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist