Provider Demographics
NPI:1629131990
Name:DELMONTE, MICHAEL J (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:DELMONTE
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 MAIN ST
Mailing Address - Street 2:#9D
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3352
Mailing Address - Country:US
Mailing Address - Phone:716-868-8863
Mailing Address - Fax:
Practice Address - Street 1:3901 MAIN ST
Practice Address - Street 2:#9D
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226-3352
Practice Address - Country:US
Practice Address - Phone:716-868-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR029890-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01812037Medicaid