Healthcare Provider Details

I. General information

NPI: 1326166166
Provider Name (Legal Business Name): DELISA ANN LUSBY AAS CAAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N ORANGE ST 2ND FLOOR
WILMINGTON DE
19801-2296
US

IV. Provider business mailing address

PO BOX 245
QUINTON NJ
08072-0245
US

V. Phone/Fax

Practice location:
  • Phone: 302-656-4044
  • Fax: 302-656-3439
Mailing address:
  • Phone: 302-373-8892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: