Provider Demographics
NPI:1326166166
Name:LUSBY, DELISA ANN (AAS CAAC)
Entity Type:Individual
Prefix:MISS
First Name:DELISA
Middle Name:ANN
Last Name:LUSBY
Suffix:
Gender:F
Credentials:AAS CAAC
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 245
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08072-0245
Mailing Address - Country:US
Mailing Address - Phone:302-373-8892
Mailing Address - Fax:
Practice Address - Street 1:625 N ORANGE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-2296
Practice Address - Country:US
Practice Address - Phone:302-656-4044
Practice Address - Fax:302-656-3439
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE103TP2701XMedicaid