Provider Demographics
NPI:1487472809
Name:DELUCA, NICOLLE (LPC)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:
Last Name:DELUCA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 NORTHMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT EPHRAIM
Mailing Address - State:NJ
Mailing Address - Zip Code:08059-1043
Mailing Address - Country:US
Mailing Address - Phone:609-504-6427
Mailing Address - Fax:
Practice Address - Street 1:6103 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-1754
Practice Address - Country:US
Practice Address - Phone:856-486-9097
Practice Address - Fax:856-486-1098
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00477100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health