Provider Demographics
NPI:1508278953
Name:DELUCA, TIMOTHY (BSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:DELUCA
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CUMMINGS CTR
Mailing Address - Street 2:SUITE 364-U
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6175
Mailing Address - Country:US
Mailing Address - Phone:978-998-3686
Mailing Address - Fax:978-922-0098
Practice Address - Street 1:800 CUMMINGS CTR
Practice Address - Street 2:SUITE 364-U
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6175
Practice Address - Country:US
Practice Address - Phone:978-998-3686
Practice Address - Fax:978-922-0098
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical