Provider Demographics
NPI:1427142041
Name:DELUCIA-WILLETTE, ANITA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MARIE
Last Name:DELUCIA-WILLETTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 VICTOR ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473
Mailing Address - Country:US
Mailing Address - Phone:203-234-0538
Mailing Address - Fax:
Practice Address - Street 1:6900 MAIN STREET
Practice Address - Street 2:M/S S515A
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615
Practice Address - Country:US
Practice Address - Phone:203-386-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004434174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist