Provider Demographics
NPI:1295136596
Name:ETU, CHERYL DELUCA (LICSW-MA, LCSW- NY)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DELUCA
Last Name:ETU
Suffix:
Gender:F
Credentials:LICSW-MA, LCSW- NY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 AMETHYST DR
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-9499
Mailing Address - Country:US
Mailing Address - Phone:978-500-0057
Mailing Address - Fax:
Practice Address - Street 1:7 AMETHYST DR
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-9499
Practice Address - Country:US
Practice Address - Phone:978-500-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-06
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA1234271041C0700X
NY0923371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical