Provider Demographics
NPI:1073107371
Name:LUCISANO, CATHY
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:LUCISANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:ANN
Other - Last Name:CORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 MIDDLESEX RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1127
Mailing Address - Country:US
Mailing Address - Phone:585-286-2998
Mailing Address - Fax:
Practice Address - Street 1:138 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1127
Practice Address - Country:US
Practice Address - Phone:585-490-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013248101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health