Healthcare Provider Details

I. General information

NPI: 1932227295
Provider Name (Legal Business Name): BENJAMIN DELAFUENTE ALBAN JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 N CALIFORNIA ST
STOCKTON CA
95202-1515
US

IV. Provider business mailing address

1414 N CALIFORNIA ST
STOCKTON CA
95202-1515
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-2385
  • Fax: 209-468-8024
Mailing address:
  • Phone: 209-468-2385
  • Fax: 209-468-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17773
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: