Provider Demographics
NPI:1518368331
Name:DELGADO, ANDREW MARCUS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MARCUS
Last Name:DELGADO
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:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-1045
Mailing Address - Country:US
Mailing Address - Phone:707-572-9440
Mailing Address - Fax:
Practice Address - Street 1:3750 ROHNERVILLE ROAD
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540
Practice Address - Country:US
Practice Address - Phone:707-725-6101
Practice Address - Fax:707-725-2978
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL6320104100000X, 1041C0700X
CALCSW872931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR179477Medicare PIN