Healthcare Provider Details

I. General information

NPI: 1831013515
Provider Name (Legal Business Name): PHILIP C DELUCA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BAY RIDGE PKWY
BROOKLYN NY
11209-2301
US

IV. Provider business mailing address

121 BAY RIDGE PKWY
BROOKLYN NY
11209-2301
US

V. Phone/Fax

Practice location:
  • Phone: 347-576-8036
  • Fax: 718-921-1092
Mailing address:
  • Phone: 347-576-8036
  • Fax: 718-921-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR020686-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: