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General NPI Number Information
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NPI Number | 1013444694
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Entity Type | Individual
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Provider Name | DOLORES DEGIACOMO LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 2129 AITKIN LOOP
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City | LEESBURG
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State | FL
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Zip | 34748-2955
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Country | US
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Telephone | 917-270-7027
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Fax |
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Provider Business Mailing Address
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Address Line | 204 WEST SQ
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City | BLUFFTON
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State | SC
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Zip | 29910-5133
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Country | US
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Telephone | 917-270-7027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05925300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | TPSW2746
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License Number State | FL
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