Provider Demographics
NPI:1871669747
Name:LUCAS, BRENDA LOUISE (MASTER OF ARTS MA)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LOUISE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MASTER OF ARTS MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004
Mailing Address - Country:US
Mailing Address - Phone:215-575-9254
Mailing Address - Fax:610-664-3749
Practice Address - Street 1:ONE PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004
Practice Address - Country:US
Practice Address - Phone:215-575-9254
Practice Address - Fax:610-664-3749
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000148106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist