Provider Demographics
NPI:1467771220
Name:DELUCCIA, LUPITA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LUPITA
Middle Name:
Last Name:DELUCCIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GATEWAY PLZ
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4674
Mailing Address - Country:US
Mailing Address - Phone:914-937-2320
Mailing Address - Fax:
Practice Address - Street 1:1 GATEWAY PLZ
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4674
Practice Address - Country:US
Practice Address - Phone:914-937-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077275104100000X
NY0832691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker