Provider Demographics
NPI:1891067401
Name:LUCHANSKY, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LUCHANSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6976 PROFESSIONAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8414
Mailing Address - Country:US
Mailing Address - Phone:941-308-4641
Mailing Address - Fax:941-342-6189
Practice Address - Street 1:4167 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2403
Practice Address - Country:US
Practice Address - Phone:941-219-3111
Practice Address - Fax:941-894-1322
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-78729106S00000X
FLSW145841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1041C0700XMedicaid