Provider Demographics
NPI:1346714953
Name:LUCIDO, PETER ANTHONY JR
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANTHONY
Last Name:LUCIDO
Suffix:JR
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 1:1806 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5662
Mailing Address - Country:US
Mailing Address - Phone:925-726-6229
Mailing Address - Fax:
Practice Address - Street 1:1806 HEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5662
Practice Address - Country:US
Practice Address - Phone:925-726-6229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health