MEDICARE: MR. STEPHEN RICHARD DELUCA LMFT

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	106H00000X	Marriage & Family Therapist	MF000256	PA

General Provider Information

NPI Number	:	1588871339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN RICHARD DELUCA LMFT

Provider Business Mailing Address
First Line	:	243 S 46TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-4514
Country	:	US
Telephone Number	:	215-386-0543
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 S 46TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-4514
Country	:	US
Telephone Number	:	215-386-0543
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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