Provider Demographics
NPI:1396826228
Name:LUCIANO, EVELYN MAGDALEN (RN,MA, NCC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:MAGDALEN
Last Name:LUCIANO
Suffix:
Gender:F
Credentials:RN,MA, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N MAGNOLIA AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3844
Mailing Address - Country:US
Mailing Address - Phone:407-963-5664
Mailing Address - Fax:
Practice Address - Street 1:1800 PEMBROOK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6928
Practice Address - Country:US
Practice Address - Phone:407-667-3447
Practice Address - Fax:407-805-9807
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health