Provider Demographics
NPI:1467659680
Name:LUCAS, JUDITH (MA)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-4227
Mailing Address - Country:US
Mailing Address - Phone:304-647-4872
Mailing Address - Fax:304-647-5366
Practice Address - Street 1:102 GOHEEN ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1600
Practice Address - Country:US
Practice Address - Phone:304-647-4872
Practice Address - Fax:304-647-5366
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV189103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0165393000Medicaid
WV0165393000Medicaid
WVCP32881Medicare PIN