Provider Demographics
NPI:1679227771
Name:DELARDAS, STAVROS E (LMSW, PMH-C, CLC)
Entity Type:Individual
Prefix:
First Name:STAVROS
Middle Name:E
Last Name:DELARDAS
Suffix:
Gender:M
Credentials:LMSW, PMH-C, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 CORRELL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1772
Mailing Address - Country:US
Mailing Address - Phone:718-290-5937
Mailing Address - Fax:
Practice Address - Street 1:470 CORRELL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1772
Practice Address - Country:US
Practice Address - Phone:718-290-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112496104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty