Provider Demographics
NPI:1124861653
Name:DELUCA, MADALINE (BSW)
Entity type:Individual
Prefix:
First Name:MADALINE
Middle Name:
Last Name:DELUCA
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:MADALINE
Other - Middle Name:
Other - Last Name:SIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2805 S INDUSTRIAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5250 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1580
Practice Address - Country:US
Practice Address - Phone:269-425-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator