Provider Demographics
NPI:1558020339
Name:DELGADO, JACOB RAFAEL (MA, AMFT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:RAFAEL
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S PROSPECT AVE APT 220
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3946
Mailing Address - Country:US
Mailing Address - Phone:424-360-5998
Mailing Address - Fax:
Practice Address - Street 1:415 S PROSPECT AVE APT 220
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3946
Practice Address - Country:US
Practice Address - Phone:424-360-5998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty