Provider Demographics
NPI:1255829669
Name:DELUCA, CHRISTIE (MS)
Entity type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:
Last Name:DELUCA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 MARLBOROUGH ST APT 11
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 590W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6163
Practice Address - Country:US
Practice Address - Phone:310-423-1220
Practice Address - Fax:310-423-1230
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5808235Z00000X
NY027429235Z00000X
MA76986235Z00000X
CA29389235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist