Healthcare Provider Details

I. General information

NPI: 1245547082
Provider Name (Legal Business Name): GINA FAY DELUCCA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 MARKET ST SUITE 340
SAN FRANCISCO CA
94102-3099
US

IV. Provider business mailing address

947A STEINER ST
SAN FRANCISCO CA
94117-1619
US

V. Phone/Fax

Practice location:
  • Phone: 415-632-1010
  • Fax:
Mailing address:
  • Phone: 515-571-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: