Healthcare Provider Details

I. General information

NPI: 1104900208
Provider Name (Legal Business Name): DEL GIACCOS CREATIVE ARTS THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 LISHAKILL RD
COLONIE NY
12205-3612
US

IV. Provider business mailing address

27 LISHAKILL RD
COLONIE NY
12205-3612
US

V. Phone/Fax

Practice location:
  • Phone: 518-518-2757
  • Fax: 518-724-6406
Mailing address:
  • Phone: 518-248-2757
  • Fax: 518-248-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number000374-1
License Number StateNY

VIII. Authorized Official

Name: MAUREEN C DELGIACCO
Title or Position: ART THERAPIST
Credential: LCAT
Phone: 518-248-2757