Healthcare Provider Details

I. General information

NPI: 1821018698
Provider Name (Legal Business Name): KENNETH A. DE LUCA,PH.D. & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 JAYCOX RD
NORTH RIDGEVILLE OH
44039-1611
US

IV. Provider business mailing address

6401 JAYCOX RD
NORTH RIDGEVILLE OH
44039-1611
US

V. Phone/Fax

Practice location:
  • Phone: 440-327-1800
  • Fax: 440-327-1533
Mailing address:
  • Phone: 440-327-1800
  • Fax: 440-327-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2076
License Number StateOH

VIII. Authorized Official

Name: DR. CATHERINE M BRANDON
Title or Position: OWNER & PRESIDENT
Credential: PSYD
Phone: 440-327-1800