Healthcare Provider Details

I. General information

NPI: 1114220829
Provider Name (Legal Business Name): JOSEPH N DELUCA, PHD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 CENTERPOINTE CIRCLE SUITE 1280
ALTAMONTE SPRINGS FL
32701
US

IV. Provider business mailing address

378 CENTERPOINTE CIRCLE SUITE 1280
ALTAMONTE SPRINGS FL
32701
US

V. Phone/Fax

Practice location:
  • Phone: 407-862-5959
  • Fax: 407-774-5573
Mailing address:
  • Phone: 407-862-5959
  • Fax: 407-774-5573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH N. DELUCA
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 407-862-5959