MEDICARE: MS. ERIN COLLEEN DELIZZIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904010009	VA

General Provider Information

NPI Number	:	1295972461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN COLLEEN DELIZZIO

Provider Business Mailing Address
First Line	:	107 S 5TH ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23219-3825
Country	:	US
Telephone Number	:	804-819-4089
Fax Number	:	804-819-5221

Provider Business Practice Location Address
First Line	:	665 PELHAM PKWY N APT 402
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-8070
Country	:	US
Telephone Number	:	718-519-8326
Fax Number	:	718-881-8714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	02/12/2018

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