Provider Demographics
NPI:1093346843
Name:D'ELIA, VINCENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:D'ELIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 KINGSTON LN
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1156
Mailing Address - Country:US
Mailing Address - Phone:973-219-3213
Mailing Address - Fax:
Practice Address - Street 1:3 KINGSTON LN
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1156
Practice Address - Country:US
Practice Address - Phone:973-219-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00418300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist