Provider Demographics
NPI:1861673899
Name:LUCAS, BERNIE (MED)
Entity Type:Individual
Prefix:MR
First Name:BERNIE
Middle Name:
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 IROQUOIS AVE
Mailing Address - Street 2:
Mailing Address - City:HARBORCREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16421-1009
Mailing Address - Country:US
Mailing Address - Phone:814-899-7664
Mailing Address - Fax:814-899-3075
Practice Address - Street 1:5712 IROQUOIS AVE
Practice Address - Street 2:
Practice Address - City:HARBORCREEK
Practice Address - State:PA
Practice Address - Zip Code:16421-1009
Practice Address - Country:US
Practice Address - Phone:814-899-7664
Practice Address - Fax:814-899-3075
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)