MEDICARE: MISS DERONDA DELPHINE METZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C006212	NC

General Provider Information

NPI Number	:	1467696864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DERONDA DELPHINE METZ LCSW

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1614 FLYNWOOD DR APT C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-3873
Country	:	US
Telephone Number	:	704-910-1902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	11/13/2024

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