Provider Demographics
NPI:1346946456
Name:DELUCA, MACI LOREN
Entity Type:Individual
Prefix:
First Name:MACI
Middle Name:LOREN
Last Name:DELUCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5918 ROXBURY DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5130
Mailing Address - Country:US
Mailing Address - Phone:901-496-8296
Mailing Address - Fax:
Practice Address - Street 1:5545 MURRAY AVE STE 204
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3898
Practice Address - Country:US
Practice Address - Phone:901-496-8296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health