Provider Demographics
NPI:1053506394
Name:DELUCA, BARBARA A (LMHC, LMT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:DELUCA
Suffix:
Gender:F
Credentials:LMHC, LMT
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 66
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-0066
Mailing Address - Country:US
Mailing Address - Phone:505-699-2254
Mailing Address - Fax:
Practice Address - Street 1:625 KINGMAN AVE APT B
Practice Address - Street 2:BOX 66
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-4104
Practice Address - Country:US
Practice Address - Phone:505-699-2254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMT 2903225700000X
NM0091361101YM0800X
NM2903173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No173C00000XOther Service ProvidersReflexologist