Provider Demographics
NPI:1467830901
Name:MCINERNEY, LUCINDIA
Entity Type:Individual
Prefix:
First Name:LUCINDIA
Middle Name:
Last Name:MCINERNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 POLE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1225
Mailing Address - Country:US
Mailing Address - Phone:203-241-6779
Mailing Address - Fax:
Practice Address - Street 1:30 PARK LN E
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2510
Practice Address - Country:US
Practice Address - Phone:860-355-0971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001050225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant