MEDICARE: STEVEN DEL RE

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1699122754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN DEL RE

Provider Business Mailing Address
First Line	:	1057 AUTUMN PINES DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-2704
Country	:	US
Telephone Number	:	813-777-0148
Fax Number	:

Provider Business Practice Location Address
First Line	:	6707 CRESCENT WOODS CIR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-4626
Country	:	US
Telephone Number	:	813-777-0148
Fax Number	:

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	12/09/2024

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