Healthcare Provider Details

I. General information

NPI: 1518462357
Provider Name (Legal Business Name): MICHAEL DELAUNAY LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W MARKET ST
SCRANTON PA
18508-1948
US

IV. Provider business mailing address

130 W MARKET ST
SCRANTON PA
18508-1948
US

V. Phone/Fax

Practice location:
  • Phone: 570-800-5895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW135075
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: