Provider Demographics
NPI:1346406451
Name:JODI J DE LUCA PHD PA
Entity Type:Organization
Organization Name:JODI J DE LUCA PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:J
Authorized Official - Last Name:DE LUCA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-920-9590
Mailing Address - Street 1:16018 SHINNECOCK DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-5717
Mailing Address - Country:US
Mailing Address - Phone:813-920-9590
Mailing Address - Fax:813-749-0484
Practice Address - Street 1:12167 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1732
Practice Address - Country:US
Practice Address - Phone:813-386-6800
Practice Address - Fax:813-891-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7169103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty