Provider Demographics
NPI:1629172879
Name:DELGADO, JOSE JUAN (MA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JUAN
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HINDENBURG STR. 24A
Mailing Address - Street 2:
Mailing Address - City:RUEDENHAUSE
Mailing Address - State:BAVARIA
Mailing Address - Zip Code:97355
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 454 BOX 2062
Practice Address - Street 2:JOSE J DELGADO
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09250
Practice Address - Country:US
Practice Address - Phone:314-467-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR012101YA0400X
PR310103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)