Provider Demographics
NPI:1194469619
Name:MCCARREN, LUCAS JOHN
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:JOHN
Last Name:MCCARREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 ALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1302
Mailing Address - Country:US
Mailing Address - Phone:201-566-0094
Mailing Address - Fax:
Practice Address - Street 1:29 ALBERT AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1302
Practice Address - Country:US
Practice Address - Phone:201-566-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist