Provider Demographics
NPI:1790959559
Name:DELIGENT, BERTHONY
Entity Type:Individual
Prefix:
First Name:BERTHONY
Middle Name:
Last Name:DELIGENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6177 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-5397
Mailing Address - Country:US
Mailing Address - Phone:772-453-8760
Mailing Address - Fax:772-774-8944
Practice Address - Street 1:6177 56TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-5397
Practice Address - Country:US
Practice Address - Phone:772-453-8760
Practice Address - Fax:772-774-8944
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional