Provider Demographics
NPI:1639282247
Name:PRIEST, LUCY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LUCY
Middle Name:
Last Name:PRIEST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAIN ST
Mailing Address - Street 2:OLD MILL SUITE 8
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-3654
Mailing Address - Country:US
Mailing Address - Phone:860-572-4995
Mailing Address - Fax:860-572-4987
Practice Address - Street 1:11 MAIN ST
Practice Address - Street 2:OLD MILL SUITE 8
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-3654
Practice Address - Country:US
Practice Address - Phone:860-572-4995
Practice Address - Fax:860-572-4987
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0054131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004229169Medicaid
CT004229169Medicaid