Provider Demographics
NPI:1942828553
Name:DELGADO, JORGE LUIS (CASAC 2)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:DELGADO
Suffix:
Gender:M
Credentials:CASAC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3178 BAYVIEW AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1838
Mailing Address - Country:US
Mailing Address - Phone:347-583-5551
Mailing Address - Fax:
Practice Address - Street 1:3178 BAYVIEW AVE APT 6B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1838
Practice Address - Country:US
Practice Address - Phone:347-583-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26090101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)