Healthcare Provider Details

I. General information

NPI: 1184145468
Provider Name (Legal Business Name): DELANEY PAIGE HERMAN LCSW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DELANEY PAIGE BLOEMKE LCSW

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MUELLER BLVD STE 103
AUSTIN TX
78723-3079
US

IV. Provider business mailing address

650 SCARBOUROUGH
CANYON LAKE TX
78133-4529
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-0040
  • Fax:
Mailing address:
  • Phone: 830-964-4390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number64409
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: