Provider Demographics
NPI:1760222020
Name:DELGADO, ANGELICA DEZARIE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:DEZARIE
Last Name:DELGADO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 ROLFE RD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3149
Mailing Address - Country:US
Mailing Address - Phone:773-860-6357
Mailing Address - Fax:
Practice Address - Street 1:1023 STATION DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-5007
Practice Address - Country:US
Practice Address - Phone:224-300-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst