Provider Demographics
NPI:1295889285
Name:DELANEY, MARY G (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:G
Last Name:DELANEY
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 1:255 W MENDOCINO AVE
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-3413
Mailing Address - Country:US
Mailing Address - Phone:707-456-0517
Mailing Address - Fax:
Practice Address - Street 1:255 W MENDOCINO AVE
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-3413
Practice Address - Country:US
Practice Address - Phone:707-456-0517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#LCS15729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW 157290Medicaid
CACSW 157290Medicaid