Provider Demographics
NPI:1104582816
Name:STATE OF DE
Entity type:Organization
Organization Name:STATE OF DE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-255-2838
Mailing Address - Street 1:DSAMH, OFFICE OF THE MEDICAL DIRECTOR
Mailing Address - Street 2:1901 N. DUPONT HIGHWAY
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720
Mailing Address - Country:US
Mailing Address - Phone:302-255-9399
Mailing Address - Fax:
Practice Address - Street 1:DSAMH, OFFICE OF THE MEDICAL DIRECTOR
Practice Address - Street 2:1901 N. DUPONT HIGHWAY
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720
Practice Address - Country:US
Practice Address - Phone:302-255-9399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental