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General NPI Number Information
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NPI Number | 1457824682
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Entity Type | Individual
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Provider Name | MARK ANTHONY DEGLIOBIZZI JR.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 86 SORRENTO DR
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City | CLAYTON
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State | DE
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Zip | 19938-4294
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Country | US
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Telephone | 302-653-3135
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Fax |
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Provider Business Mailing Address
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Address Line | 101 ARCADIA PKWY
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1329
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Country | US
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Telephone |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 82734
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License Number State | DE
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