Provider Demographics
NPI:1699788083
Name:DE LUCA, JODI J (PHD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:J
Last Name:DE LUCA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-0944
Mailing Address - Country:US
Mailing Address - Phone:720-504-9444
Mailing Address - Fax:303-997-8296
Practice Address - Street 1:671 MITCHELL WAY STE 109
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-5445
Practice Address - Country:US
Practice Address - Phone:720-504-9444
Practice Address - Fax:303-997-8296
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3669103TC0700X
FLPY-7169103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
262672861OtherTAX ID
FL29432Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER