Provider Demographics
NPI:1821018698
Name:KENNETH A. DE LUCA,PH.D. & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:KENNETH A. DE LUCA,PH.D. & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:440-327-1800
Mailing Address - Street 1:6401 JAYCOX RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-1611
Mailing Address - Country:US
Mailing Address - Phone:440-327-1800
Mailing Address - Fax:440-327-1533
Practice Address - Street 1:6401 JAYCOX RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-1611
Practice Address - Country:US
Practice Address - Phone:440-327-1800
Practice Address - Fax:440-327-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2076103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKE9291621Medicare ID - Type Unspecified