Healthcare Provider Details

I. General information

NPI: 1467893990
Provider Name (Legal Business Name): MELISSA SANTAGUIDA DELUCA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ROUTE 33 SUITE 9-10
NEPTUNE NJ
07753-6102
US

IV. Provider business mailing address

226 VALLEY RD
NEPTUNE NJ
07753-5769
US

V. Phone/Fax

Practice location:
  • Phone: 732-988-3441
  • Fax: 732-988-7123
Mailing address:
  • Phone: 732-773-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: