Provider Demographics
NPI:1437880820
Name:LUCANIE, MELANIE LISA (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LISA
Last Name:LUCANIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 SWAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4956
Mailing Address - Country:US
Mailing Address - Phone:845-709-9183
Mailing Address - Fax:
Practice Address - Street 1:360 MAIN ST # 2D
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3375
Practice Address - Country:US
Practice Address - Phone:860-248-6046
Practice Address - Fax:844-264-0237
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0918961041C0700X
CT122661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical