Provider Demographics
NPI:1336234335
Name:DELUCA, ANDREA HELEN (MSW PSAD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:HELEN
Last Name:DELUCA
Suffix:
Gender:F
Credentials:MSW PSAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6625
Mailing Address - Country:US
Mailing Address - Phone:718-698-0700
Mailing Address - Fax:
Practice Address - Street 1:2295 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6625
Practice Address - Country:US
Practice Address - Phone:718-698-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0001031103TP0814X
NYPR022462-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02027154Medicaid
NY02027154Medicaid
NYN18541Medicare ID - Type Unspecified