Provider Demographics
NPI:1316545569
Name:DELLALUCIA, DENVER
Entity Type:Individual
Prefix:
First Name:DENVER
Middle Name:
Last Name:DELLALUCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6738 WILD INDIGO DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-8826
Mailing Address - Country:US
Mailing Address - Phone:503-702-5323
Mailing Address - Fax:
Practice Address - Street 1:6805 CORPORATE DR STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1977
Practice Address - Country:US
Practice Address - Phone:719-726-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH.61473172101YM0800X
HI521140106S00000X
COLPC.0018941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician