Provider Demographics
NPI:1578713921
Name:LUCCA RODRIGUEZ, JOSE ALEJANDRO (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:LUCCA RODRIGUEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB EXT ALTA VISTA CALLE 11 XX-1
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-718-2589
Mailing Address - Fax:
Practice Address - Street 1:URB. PERLA DEL SUR
Practice Address - Street 2:CALLE CARLOS CARTAGENA 4009 SUITE B
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-718-2589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3117103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical