Provider Demographics
NPI:1013444694
Name:DEGIACOMO, DOLORES (LCSW)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:DEGIACOMO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 WEST SQ
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5133
Mailing Address - Country:US
Mailing Address - Phone:917-270-7027
Mailing Address - Fax:
Practice Address - Street 1:2129 AITKIN LOOP
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-2955
Practice Address - Country:US
Practice Address - Phone:917-270-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059253001041C0700X
FLTPSW27461041C0700X
NJ44SL05890400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty