Provider Demographics
NPI:1023176047
Name:DELCANTO-ELLINGTON, MAYA ANNETTE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MAYA
Middle Name:ANNETTE
Last Name:DELCANTO-ELLINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:DELCANTO
Other - Last Name:DELCANTO-ELLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2525 WALLINGWOOD DR
Mailing Address - Street 2:SUITE 701
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6900
Mailing Address - Country:US
Mailing Address - Phone:512-426-6889
Mailing Address - Fax:800-939-2317
Practice Address - Street 1:2525 WALLINGWOOD DR
Practice Address - Street 2:SUITE 701
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6900
Practice Address - Country:US
Practice Address - Phone:512-426-6889
Practice Address - Fax:800-939-2317
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350471041C0700X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0021KMOtherBLUE CROSS BLUE SHIELD TX
TX180637401Medicaid