Provider Demographics
NPI:1700363041
Name:DELISLE-DALEY, BRIDGIT SUSAN
Entity Type:Individual
Prefix:
First Name:BRIDGIT
Middle Name:SUSAN
Last Name:DELISLE-DALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3577 SW CORPORATE PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-8153
Mailing Address - Country:US
Mailing Address - Phone:772-220-3439
Mailing Address - Fax:772-220-3438
Practice Address - Street 1:1591 SW HACKENSACK AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6520
Practice Address - Country:US
Practice Address - Phone:917-302-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker