Provider Demographics
NPI:1952373482
Name:DELUCAS, ANN LARAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:LARAINE
Last Name:DELUCAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 SAN MARINO DR.
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:97078
Mailing Address - Country:US
Mailing Address - Phone:760-471-2033
Mailing Address - Fax:760-471-2083
Practice Address - Street 1:1146 SAN MARINO DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4649
Practice Address - Country:US
Practice Address - Phone:760-471-2033
Practice Address - Fax:760-471-2083
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical