Healthcare Provider Details

I. General information

NPI: 1053506394
Provider Name (Legal Business Name): BARBARA A DELUCA LMHC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 KINGMAN AVE APT B BOX 66
GRANTS NM
87020-4104
US

IV. Provider business mailing address

PO BOX 66
GRANTS NM
87020-0066
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-2254
  • Fax:
Mailing address:
  • Phone: 505-699-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT 2903
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0091361
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number2903
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: