Provider Demographics
NPI:1083164644
Name:MAYO, LUCIANA GENEVIEVE (LBS)
Entity Type:Individual
Prefix:MS
First Name:LUCIANA
Middle Name:GENEVIEVE
Last Name:MAYO
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ENGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1517
Mailing Address - Country:US
Mailing Address - Phone:267-319-6162
Mailing Address - Fax:
Practice Address - Street 1:4 NESHAMINY INTERPLEX DR
Practice Address - Street 2:SUITE 202
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6944
Practice Address - Country:US
Practice Address - Phone:215-322-8860
Practice Address - Fax:215-332-8867
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003123106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst