Provider Demographics
NPI:1821159161
Name:LUCCA, SALVATORE J
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:J
Last Name:LUCCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WIDGEON LN
Mailing Address - Street 2:
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-3819
Mailing Address - Country:US
Mailing Address - Phone:508-776-9251
Mailing Address - Fax:
Practice Address - Street 1:572 ROUTE 28
Practice Address - Street 2:PARE & ASSOCIATES
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-4909
Practice Address - Country:US
Practice Address - Phone:508-775-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA217612OtherCLINICAL MENTAL HEALTH CO