MEDICARE: MR. MARIANO DELPILAR LMSW

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	0731481	NY

General Provider Information

NPI Number	:	1649341314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARIANO DELPILAR LMSW

Provider Business Mailing Address
First Line	:	603 WEST 138TH STREET
Second Line	:	APT 61
City	:	NEW YORK
State	:	NY
Zip	:	10031
Country	:	US
Telephone Number	:	212-690-9111
Fax Number	:	718-665-1174

Provider Business Practice Location Address
First Line	:	1285 FULTON AVE
Second Line	:	LIFE RECOVERY CENTER BRONX LEBANON CENTER
City	:	BRONX
State	:	NY
Zip	:	10456-3401
Country	:	US
Telephone Number	:	718-518-3755
Fax Number	:	718-518-3710

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	09/23/2015

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