1366552473 NPI number — DR. DEMETRIA E DELIA PHD LCSW

Table of content: DR. DEMETRIA E DELIA PHD LCSW (NPI 1366552473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366552473 NPI number — DR. DEMETRIA E DELIA PHD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELIA
Provider First Name:
DEMETRIA
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366552473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 JOHNSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWFOUNDLAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07435-1128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-697-9311
Provider Business Mailing Address Fax Number:
973-697-0886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 S EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07090-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-242-6001
Provider Business Practice Location Address Fax Number:
973-697-0886
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  44SC00019400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P409123 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 175544 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".




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