Provider Demographics
NPI:1629508627
Name:DELORETTO, JUSTIN JAMES (MSW, QMHP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JAMES
Last Name:DELORETTO
Suffix:
Gender:M
Credentials:MSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 BEVERLY AVE NE BLDG G
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1319
Mailing Address - Country:US
Mailing Address - Phone:503-585-4977
Mailing Address - Fax:
Practice Address - Street 1:3876 BEVERLY AVE NE BLDG G
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1319
Practice Address - Country:US
Practice Address - Phone:503-585-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker