Basic Information
| Provider Information | |||||||||
| NPI: | 1720496839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELGADO | ||||||||
| FirstName: | JARIS | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 MERCURY CT | ||||||||
| Address2: | ARMS APARTMENTS L2 | ||||||||
| City: | WEST SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010893282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874786498 | ||||||||
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| Practice Location | |||||||||
| Address1: | 417 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011043736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137470705 | ||||||||
| FaxNumber: | 4137327075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2014 | ||||||||
| LastUpdateDate: | 08/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | XXXX | PR | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.