MEDICARE: EILEEN DELHAGEN MSW, 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	101YM0800X	Mental Health Counselor	44SC00845400	NJ

General Provider Information

NPI Number	:	1972570216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN DELHAGEN MSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1926
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-1071
Country	:	US
Telephone Number	:	732-701-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2095 ROUTE 88
Second Line	:	SUITE 3
City	:	BRICK
State	:	NJ
Zip	:	08724-3265
Country	:	US
Telephone Number	:	732-701-0440
Fax Number	:	732-701-0419

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	06/12/2008

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