Provider Demographics
NPI:1770653727
Name:KERRY K DELK, PHD, INCORPORATED
Entity Type:Organization
Organization Name:KERRY K DELK, PHD, INCORPORATED
Other - Org Name:NEWPORT PSYCHOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DELK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-540-5010
Mailing Address - Street 1:20371 IRVINE AVE
Mailing Address - Street 2:STE A160
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5651
Mailing Address - Country:US
Mailing Address - Phone:714-540-5010
Mailing Address - Fax:714-540-5020
Practice Address - Street 1:20371 IRVINE AVE
Practice Address - Street 2:STE A160
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-5651
Practice Address - Country:US
Practice Address - Phone:714-540-5010
Practice Address - Fax:714-540-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12297Medicare PIN