1902149719 NPI number — DR CONSTANCE DELGIUDICE PLLC

Table of content: (NPI 1902149719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902149719 NPI number — DR CONSTANCE DELGIUDICE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR CONSTANCE DELGIUDICE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902149719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 SE FEDERAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34994-4531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-631-6138
Provider Business Mailing Address Fax Number:
772-221-3192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 SE FEDERAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34994-4531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-631-6138
Provider Business Practice Location Address Fax Number:
772-221-3192
Provider Enumeration Date:
03/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DELGIUDICE
Authorized Official First Name:
CONSTANCE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
LICENSED MENTAL HEALTH COUNSELOR
Authorized Official Telephone Number:
772-631-6138

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH9049 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001414800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013069600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com