Provider Demographics
NPI:1619206042
Name:LUKAS, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LUKAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LUKAS
Other - Last Name:PERRAULT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:39 WEST CHURCH ST.
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843
Mailing Address - Country:US
Mailing Address - Phone:802-472-6694
Mailing Address - Fax:
Practice Address - Street 1:39 WEST CHURCH ST.
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843
Practice Address - Country:US
Practice Address - Phone:802-472-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor