Provider Demographics
NPI:1376869750
Name:SMITH, LUCIA WALLIS (MA)
Entity Type:Individual
Prefix:MS
First Name:LUCIA
Middle Name:WALLIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:LUCIA
Other - Middle Name:ANN
Other - Last Name:WALLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:115 S MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08611-1727
Mailing Address - Country:US
Mailing Address - Phone:609-902-3271
Mailing Address - Fax:
Practice Address - Street 1:115 S MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-1727
Practice Address - Country:US
Practice Address - Phone:609-902-3271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-11
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00030700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional