MEDICARE: NICOLLE DELUCA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37PC00477100	NJ

General Provider Information

NPI Number	:	1487472809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLLE DELUCA LPC

Provider Business Mailing Address
First Line	:	41 NORTHMONT AVE
Second Line	:
City	:	MOUNT EPHRAIM
State	:	NJ
Zip	:	08059-1043
Country	:	US
Telephone Number	:	609-504-6427
Fax Number	:

Provider Business Practice Location Address
First Line	:	6103 WESTFIELD AVE
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1754
Country	:	US
Telephone Number	:	856-486-9097
Fax Number	:	856-486-1098

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	10/03/2024

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