Healthcare Provider Details

I. General information

NPI: 1518368331
Provider Name (Legal Business Name): ANDREW MARCUS DELGADO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 ROHNERVILLE ROAD
FORTUNA CA
95540
US

IV. Provider business mailing address

PO BOX 1045
ARCATA CA
95518-1045
US

V. Phone/Fax

Practice location:
  • Phone: 707-725-6101
  • Fax: 707-725-2978
Mailing address:
  • Phone: 707-572-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL6320
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW87293
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6320
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: