Provider Demographics
NPI:1376125484
Name:DELAMARE, WILFORD KIMBALL (LCSW)
Entity Type:Individual
Prefix:
First Name:WILFORD
Middle Name:KIMBALL
Last Name:DELAMARE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CLUB HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-3381
Mailing Address - Country:US
Mailing Address - Phone:801-698-7704
Mailing Address - Fax:
Practice Address - Street 1:9289 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6730
Practice Address - Country:US
Practice Address - Phone:801-703-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12913635011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical