Healthcare Provider Details

I. General information

NPI: 1750484937
Provider Name (Legal Business Name): ANTHONY JAMES DELUCA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 VICTORY BLVD
STATEN ISLAND NY
10314
US

IV. Provider business mailing address

2295 VICTORY BLVD
STATEN ISLAND NY
10314
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-0700
  • Fax:
Mailing address:
  • Phone: 718-698-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0012241
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS002377L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number0000201
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number19447
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: