MEDICARE: COSETTE CRISTINA DELGADO ASW

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	101YM0800X	Mental Health Counselor	ASW21979	CA

General Provider Information

NPI Number	:	1538454616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COSETTE CRISTINA DELGADO ASW

Provider Business Mailing Address
First Line	:	516 W J ST
Second Line	:
City	:	BENICIA
State	:	CA
Zip	:	94510-3045
Country	:	US
Telephone Number	:	650-814-3204
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 CHADBOURNE RD
Second Line	:	SUITE F
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-9600
Country	:	US
Telephone Number	:	707-425-9670
Fax Number	:

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

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	06/24/2011

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