Provider Demographics
NPI:1407984248
Name:LUCHINI GERSON, CATHERINE JOSEPHINE (PT)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:JOSEPHINE
Last Name:LUCHINI GERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NEHOIDEN RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1925
Mailing Address - Country:US
Mailing Address - Phone:617-244-0587
Mailing Address - Fax:617-244-6385
Practice Address - Street 1:111 NEHOIDEN RD
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1925
Practice Address - Country:US
Practice Address - Phone:617-244-0587
Practice Address - Fax:617-244-6385
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1769171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1361139OtherAETNA
MAY65466OtherBLUE CROSS BLUE SHIELD
MAAA54250OtherHARVARD PILGRIM HEALTH
MAY65466OtherBLUE CROSS BLUE SHIELD