Provider Demographics
NPI:1578340121
Name:SAMULIS, LUCIA M (PMH-NP)
Entity Type:Individual
Prefix:MS
First Name:LUCIA
Middle Name:M
Last Name:SAMULIS
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 SILAS DEANE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4363
Mailing Address - Country:US
Mailing Address - Phone:860-545-7550
Mailing Address - Fax:
Practice Address - Street 1:1260 SILAS DEANE HWY STE 101
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4363
Practice Address - Country:US
Practice Address - Phone:860-545-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12313363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health