Provider Demographics
NPI:1609538271
Name:DELUCA, KIRSTEN MELISSA (MA; LAC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MELISSA
Last Name:DELUCA
Suffix:
Gender:F
Credentials:MA; LAC
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:MELISSA
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:216 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:08518-1311
Mailing Address - Country:US
Mailing Address - Phone:732-503-1210
Mailing Address - Fax:
Practice Address - Street 1:216 BROAD ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:NJ
Practice Address - Zip Code:08518-1311
Practice Address - Country:US
Practice Address - Phone:732-503-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00478100101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health