Provider Demographics
NPI:1336282524
Name:CIACCIO, LUKE JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:JOSEPH
Last Name:CIACCIO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4744 JANET LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8465
Mailing Address - Country:US
Mailing Address - Phone:610-758-8123
Mailing Address - Fax:
Practice Address - Street 1:850 S 5TH ST FL 4
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3308
Practice Address - Country:US
Practice Address - Phone:610-776-3214
Practice Address - Fax:610-776-3506
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008377L103TC0700X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1568536480OtherGOOD SHEPHERD PSYCH GROUP
PA030784NB0Medicare PIN
PA1568536480OtherGOOD SHEPHERD PSYCH GROUP