Provider Demographics
NPI:1417902529
Name:DELUCA, LAURIE ELLEN (MA LCDP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ELLEN
Last Name:DELUCA
Suffix:
Gender:F
Credentials:MA LCDP
Other - Prefix:MRS
Other - First Name:LAURIE
Other - Middle Name:ELLEN
Other - Last Name:CRONHIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDP MA
Mailing Address - Street 1:144 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816
Mailing Address - Country:US
Mailing Address - Phone:401-385-9360
Mailing Address - Fax:
Practice Address - Street 1:530 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5762
Practice Address - Country:US
Practice Address - Phone:401-437-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
RICDP00499101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor