Provider Demographics
NPI:1629117387
Name:DELBANCO, STEVEN MANFRED (MED, LADC-I)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MANFRED
Last Name:DELBANCO
Suffix:
Gender:M
Credentials:MED, LADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 RIVER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5483
Mailing Address - Country:US
Mailing Address - Phone:781-966-5643
Mailing Address - Fax:
Practice Address - Street 1:431 RIVER ST STE 1
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5483
Practice Address - Country:US
Practice Address - Phone:781-966-5643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1044101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042630450OtherAGENCY TAX EXEMPT NUMBER