Provider Demographics
NPI:1760583496
Name:LUCKY, JANIS ELIZABETH (LPC)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:ELIZABETH
Last Name:LUCKY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 STATE ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3147
Mailing Address - Country:US
Mailing Address - Phone:203-537-0542
Mailing Address - Fax:203-537-0542
Practice Address - Street 1:410 STATE ST
Practice Address - Street 2:SUIT #5
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3147
Practice Address - Country:US
Practice Address - Phone:203-537-0542
Practice Address - Fax:203-537-0542
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004255825Medicare UPIN