Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TP2701X | Group Psychotherapist | DE |
NPI | 1326166166 |
---|---|
Provider Name | Miss Delisa Ann Lusby |
First Address | Quinton, NJ 08072-0245 |
Second Address | Wilmington, DE 19801-2296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103TP2701X | (05) | DE |