Provider Demographics
NPI:1710598065
Name:DELUCA, JENNA MARIE (LADC, LCSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:DELUCA
Suffix:
Gender:F
Credentials:LADC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 SHARON DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-1519
Mailing Address - Country:US
Mailing Address - Phone:203-982-0526
Mailing Address - Fax:
Practice Address - Street 1:605 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1123
Practice Address - Country:US
Practice Address - Phone:203-982-0526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001373101YA0400X
CT122101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)