Provider Demographics
NPI:1386881878
Name:DELGADO, AMY LYNN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:DELGADO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1313
Mailing Address - Country:US
Mailing Address - Phone:651-340-7554
Mailing Address - Fax:
Practice Address - Street 1:300 S 6TH ST # A-1600
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55487-0999
Practice Address - Country:US
Practice Address - Phone:612-596-0739
Practice Address - Fax:612-321-3850
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN148871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical