Provider Demographics
NPI:1063573756
Name:DELUCA, DENISE ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ANN
Last Name:DELUCA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 OLD WOOD LN
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1635
Mailing Address - Country:US
Mailing Address - Phone:973-335-2164
Mailing Address - Fax:
Practice Address - Street 1:339 CHANGEBRIDGE RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9576
Practice Address - Country:US
Practice Address - Phone:201-919-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3455103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent