Provider Demographics
NPI:1548745250
Name:LUCIA, LARA (MSW, LICSW, CMHS)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:LUCIA
Suffix:
Gender:F
Credentials:MSW, LICSW, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BURNETT AVE S APT A202
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2164
Mailing Address - Country:US
Mailing Address - Phone:206-372-0299
Mailing Address - Fax:
Practice Address - Street 1:2366 EASTLASKE AVE E
Practice Address - Street 2:SUITE 335
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102
Practice Address - Country:US
Practice Address - Phone:206-639-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health