Provider Demographics
NPI:1467893990
Name:DELUCA, MELISSA SANTAGUIDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SANTAGUIDA
Last Name:DELUCA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5769
Mailing Address - Country:US
Mailing Address - Phone:732-773-0556
Mailing Address - Fax:
Practice Address - Street 1:2100 ROUTE 33
Practice Address - Street 2:SUITE 9-10
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6102
Practice Address - Country:US
Practice Address - Phone:732-988-3441
Practice Address - Fax:732-988-7123
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
NJ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool