Provider Demographics
NPI:1588186019
Name:TANNOUS, LUCAS ANDREW
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:ANDREW
Last Name:TANNOUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 GREYSTONE AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1960
Mailing Address - Country:US
Mailing Address - Phone:703-447-7245
Mailing Address - Fax:
Practice Address - Street 1:3810 GREYSTONE AVE APT 503
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1960
Practice Address - Country:US
Practice Address - Phone:703-447-7245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist