Provider Demographics
NPI:1992339691
Name:DELGADO, JUSTINA
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6714 65TH PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4637
Mailing Address - Country:US
Mailing Address - Phone:917-332-7795
Mailing Address - Fax:
Practice Address - Street 1:6714 65TH PL
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4637
Practice Address - Country:US
Practice Address - Phone:917-332-7795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician