Provider Demographics
NPI:1851417018
Name:LUCAS, JENNIFER JOAN (BS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOAN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JOAN
Other - Last Name:BURNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1022 FLORIDA AVE S
Mailing Address - Street 2:STE 6
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2145
Mailing Address - Country:US
Mailing Address - Phone:321-383-5594
Mailing Address - Fax:321-504-0955
Practice Address - Street 1:1022 FLORIDA AVE S
Practice Address - Street 2:STE 6
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2145
Practice Address - Country:US
Practice Address - Phone:321-383-5594
Practice Address - Fax:321-504-0955
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker