Provider Demographics
NPI:1164036935
Name:CARMEN L. LUCIA PSYD LLC
Entity Type:Organization
Organization Name:CARMEN L. LUCIA PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:LUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:480-980-7355
Mailing Address - Street 1:15215 S 48TH ST STE 154
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-9139
Mailing Address - Country:US
Mailing Address - Phone:480-980-7355
Mailing Address - Fax:480-718-8762
Practice Address - Street 1:15215 S 48TH ST STE 154
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9139
Practice Address - Country:US
Practice Address - Phone:480-980-7355
Practice Address - Fax:480-718-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)