Provider Demographics
NPI:1366552473
Name:DELIA, DEMETRIA E (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:DEMETRIA
Middle Name:E
Last Name:DELIA
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07435-1128
Mailing Address - Country:US
Mailing Address - Phone:973-697-9311
Mailing Address - Fax:973-697-0886
Practice Address - Street 1:134 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1120
Practice Address - Country:US
Practice Address - Phone:908-242-6001
Practice Address - Fax:973-697-0886
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00019400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
P409123OtherOXFORD
175544OtherVALUE OPTIONS
016739Medicare ID - Type Unspecified