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General NPI Number Information
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NPI Number | 1700363041
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Entity Type | Individual
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Provider Name | BRIDGIT SUSAN DELISLE-DALEY
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Gender | Female
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 1591 SW HACKENSACK AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-6520
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Country | US
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Telephone | 917-302-8440
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Fax |
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Provider Business Mailing Address
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Address Line | 3577 SW CORPORATE PKWY
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City | PALM CITY
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State | FL
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Zip | 34990-8153
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Country | US
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Telephone | 772-220-3439
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Fax | 772-220-3438
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | FL
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