Provider Demographics
NPI:1669607297
Name:DELUCA, ANTOINETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:
Last Name:DELUCA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 620
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-0620
Mailing Address - Country:US
Mailing Address - Phone:646-808-7806
Mailing Address - Fax:
Practice Address - Street 1:304 PARK AVE S
Practice Address - Street 2:SUITE 1111
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4301
Practice Address - Country:US
Practice Address - Phone:646-808-7806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018045103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist