MEDICARE: KORTNEY V DELIETO 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	SW23565	FL

General Provider Information

NPI Number	:	1598591984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORTNEY V DELIETO LCSW

Provider Business Mailing Address
First Line	:	6819 MASSACHUSETTS AVE
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-2740
Country	:	US
Telephone Number	:	352-995-9854
Fax Number	:

Provider Business Practice Location Address
First Line	:	6819 MASSACHUSETTS AVE
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-2740
Country	:	US
Telephone Number	:	352-995-9854
Fax Number	:

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

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	09/11/2024

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