Healthcare Provider Details

I. General information

NPI: 1659192763
Provider Name (Legal Business Name): MATTHEW SEAN DELCAMPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SW 136TH ST
BURIEN WA
98166-1214
US

IV. Provider business mailing address

2801 1ST AVE APT 516
SEATTLE WA
98121-1147
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-6600
  • Fax: 206-257-6825
Mailing address:
  • Phone: 253-432-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: