Provider Demographics
NPI:1487019733
Name:LUCIC, HEATHER (MSED)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:LUCIC
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:2844 43RD ST
Mailing Address - Street 2:APT 3A
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2107
Mailing Address - Country:US
Mailing Address - Phone:917-716-3723
Mailing Address - Fax:
Practice Address - Street 1:2844 43RD ST
Practice Address - Street 2:APT 3A
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2107
Practice Address - Country:US
Practice Address - Phone:917-716-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool