Provider Demographics
NPI:1629180211
Name:LUCHINI, FAUSTA MARIA (MA)
Entity Type:Individual
Prefix:MS
First Name:FAUSTA
Middle Name:MARIA
Last Name:LUCHINI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:FAUSTA
Other - Middle Name:MARIA
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1425 STORY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1735
Mailing Address - Country:US
Mailing Address - Phone:502-744-4098
Mailing Address - Fax:
Practice Address - Street 1:1425 STORY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1735
Practice Address - Country:US
Practice Address - Phone:502-744-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0058103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical