Provider Demographics
NPI:1588871339
Name:DELUCA, STEPHEN RICHARD (LMFT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RICHARD
Last Name:DELUCA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 S 46TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4514
Mailing Address - Country:US
Mailing Address - Phone:215-386-0543
Mailing Address - Fax:
Practice Address - Street 1:243 S 46TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4514
Practice Address - Country:US
Practice Address - Phone:215-386-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist