Provider Demographics
NPI:1508406315
Name:LUCIO, JOEL JR (LLMSW)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:LUCIO
Suffix:JR
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 CATHERINE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1548
Mailing Address - Country:US
Mailing Address - Phone:512-701-5705
Mailing Address - Fax:
Practice Address - Street 1:120 E LIBERTY ST STE 200124
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2156
Practice Address - Country:US
Practice Address - Phone:734-926-5314
Practice Address - Fax:734-405-6314
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68011088781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker