Provider Demographics
NPI:1376934703
Name:LUCZUN, MARY ELLEN (MSN,RN,PMHCNS-BC)
Entity Type:Individual
Prefix:PROF
First Name:MARY ELLEN
Middle Name:
Last Name:LUCZUN
Suffix:
Gender:F
Credentials:MSN,RN,PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 67TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4412
Mailing Address - Country:US
Mailing Address - Phone:347-579-4262
Mailing Address - Fax:
Practice Address - Street 1:902 QUENTIN RD
Practice Address - Street 2:TOURO COLLEGE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223
Practice Address - Country:US
Practice Address - Phone:718-236-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236915163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult