MEDICARE: MARTHA GILLIS DELAFIELD 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	000486	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35560	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1629010939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA GILLIS DELAFIELD LCSW

Provider Business Mailing Address
First Line	:	336 JOHN HORTON RD
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27523-2702
Country	:	US
Telephone Number	:	919-781-1707
Fax Number	:

Provider Business Practice Location Address
First Line	:	336 JOHN HORTON RD
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27523-2702
Country	:	US
Telephone Number	:	919-781-1707
Fax Number	:

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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