Provider Demographics
NPI:1285264382
Name:DELANCEY, DAVID JOHN (CERTIFIED ADDICTIONS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:DELANCEY
Suffix:
Gender:M
Credentials:CERTIFIED ADDICTIONS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3946
Mailing Address - Country:US
Mailing Address - Phone:860-852-1071
Mailing Address - Fax:
Practice Address - Street 1:1250 SILVER ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3946
Practice Address - Country:US
Practice Address - Phone:860-852-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5101101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)