Provider Demographics
NPI:1114910288
Name:LUCAS, LAURIE T (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:T
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DOVE ST
Mailing Address - Street 2:STE 295
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3036
Mailing Address - Country:US
Mailing Address - Phone:949-640-4674
Mailing Address - Fax:949-769-3974
Practice Address - Street 1:1151 DOVE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2840
Practice Address - Country:US
Practice Address - Phone:949-640-4674
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 140221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical