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General NPI Number Information
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NPI Number | 1689108037
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Entity Type | Organization
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Legal Business Name | LISA C. DELUCA, LCSW, PLLC
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 54895 MAIN ROAD
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City | SOUTHOLD
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State | NY
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Zip | 11971-4895
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Country | US
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Telephone | 631-903-4177
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Fax |
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Provider Business Mailing Address
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Address Line | 175 THE CROSSWAYS
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City | EAST MARION
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State | NY
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Zip | 11939-1007
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Country | US
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Telephone | 631-477-6077
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA C. DELUCA
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Credential | LCSW
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Telephone | 631-477-6077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0824701
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License Number State | NY
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