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General NPI Number Information
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NPI Number | 1538906441
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Entity Type | Individual
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Provider Name | KATHRYN DELUCA
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Gender | Female
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Dates
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Enumeration Date | 07/09/2024
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 680 CENTRE ST
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City | BROCKTON
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State | MA
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Zip | 02302-3308
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Country | US
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Telephone | 508-941-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 283 SAINT PAUL ST APT 1
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City | BROOKLINE
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State | MA
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Zip | 02446-3541
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Country | US
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Telephone | 908-216-7341
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA100924
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License Number State | MA
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