Provider Demographics
NPI:1285179374
Name:DELLORCO, MEREDITH (LCSW)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:DELLORCO
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 1:333 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3818
Mailing Address - Country:US
Mailing Address - Phone:508-254-8913
Mailing Address - Fax:203-270-4338
Practice Address - Street 1:15 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482
Practice Address - Country:US
Practice Address - Phone:203-426-8103
Practice Address - Fax:203-270-4338
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT407104100000X
CT0097151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker