Provider Demographics
NPI:1619911831
Name:DELBALZO, VINCENT (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:DELBALZO
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4238
Mailing Address - Country:US
Mailing Address - Phone:301-467-4601
Mailing Address - Fax:301-424-5518
Practice Address - Street 1:12 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4238
Practice Address - Country:US
Practice Address - Phone:301-467-4601
Practice Address - Fax:301-424-5518
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD083231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490860Medicare ID - Type Unspecified