Healthcare Provider Details

I. General information

NPI: 1609602721
Provider Name (Legal Business Name): JAY DELMONICO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W 44TH ST
ASHTABULA OH
44004-6812
US

IV. Provider business mailing address

620 W 44TH ST
ASHTABULA OH
44004-6812
US

V. Phone/Fax

Practice location:
  • Phone: 440-650-5030
  • Fax:
Mailing address:
  • Phone: 440-650-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.192751
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: