MEDICARE: MR. STEPHEN M DELO JR. LCSW

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	0904009578	VA

General Provider Information

NPI Number	:	1568917698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN M DELO JR. LCSW

Provider Business Mailing Address
First Line	:	5213 HICKORY PARK DR STE A
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2617
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

Provider Business Practice Location Address
First Line	:	5213 HICKORY PARK DR STE A
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2617
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

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

Provider Enumeration Date	:	08/18/2016
Last Update Date	:	07/16/2025

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