Provider Demographics
NPI:1588643092
Name:MARIE LUCEY, PC
Entity type:Organization
Organization Name:MARIE LUCEY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-867-4095
Mailing Address - Street 1:255 GRAPEVINE RD
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984
Mailing Address - Country:US
Mailing Address - Phone:978-867-4095
Mailing Address - Fax:978-867-4680
Practice Address - Street 1:255 GRAPEVINE RD
Practice Address - Street 2:
Practice Address - City:WENHAM
Practice Address - State:MA
Practice Address - Zip Code:01984
Practice Address - Country:US
Practice Address - Phone:978-867-4095
Practice Address - Fax:978-867-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT0267Medicare PIN