Provider Demographics
NPI:1811588072
Name:DULUC, MADELAINE NICOLE
Entity Type:Individual
Prefix:
First Name:MADELAINE
Middle Name:NICOLE
Last Name:DULUC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 NW 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PNES
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-699-7625
Mailing Address - Fax:
Practice Address - Street 1:8785 SW 165TH AVE.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193
Practice Address - Country:US
Practice Address - Phone:786-206-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-31
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician