Active NPI
Tara Deluco, PHD
- Clinical Psychologist
- Glendale, CA
National Provider Identifier
1639787062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 32957
- Practice address
- 1436 Idlewood Rd
Glendale, CA 91202-1419 - Phone
- (323) 375-4442
- NPI assigned
- Jul 22, 2020
- Last updated
- Jan 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | |||
| Clinical Psychologist | 103TC0700X | 024035 | NY | |
| Clinical Psychologist | 103TC0700X | 32957 | CA | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
1436 Idlewood Rd
Glendale, CA 91202-1419
Mailing address
1436 Idlewood Rd
Glendale, CA 91202-1419
Phone (323) 375-4442
Other practice location 1
10323 Santa Monica Blvd Ste 109-D1
Los Angeles, CA 90025-6071
Phone (860) 558-0075
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641945600000",
"number": "1639787062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1436 IDLEWOOD RD",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912021419",
"telephone_number": "323-375-4442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1436 IDLEWOOD RD",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912021419",
"telephone_number": "323-375-4442"
}
],
"practiceLocations": [
{
"address_1": "10323 Santa Monica Blvd Ste 109-D1",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900256071",
"country_code": "US",
"telephone_number": "860-558-0075",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DELUCO",
"first_name": "TARA",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-22",
"last_updated": "2022-01-12",
"certification_date": "2022-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "024035",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "32957",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.