Provider Demographics
NPI:1568632420
Name:LUCARELLI, AMY M (LIC AC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:LUCARELLI
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:AMY M.G.
Other - Middle Name:
Other - Last Name:GALVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICAC
Mailing Address - Street 1:1175 LUCERNE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-3639
Mailing Address - Country:US
Mailing Address - Phone:407-450-1993
Mailing Address - Fax:
Practice Address - Street 1:1175 LUCERNE DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-3639
Practice Address - Country:US
Practice Address - Phone:407-450-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3462171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist