Provider Demographics
NPI:1962000240
Name:DELAFIELD, FREDERICK P IV
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:P
Last Name:DELAFIELD
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:
Other - Last Name:DELAFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:679 1/2 LEVERING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2350
Mailing Address - Country:US
Mailing Address - Phone:310-989-4851
Mailing Address - Fax:
Practice Address - Street 1:679 1/2 LEVERING AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2350
Practice Address - Country:US
Practice Address - Phone:310-989-4851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)