Provider Demographics
NPI:1891289542
Name:DRISKELL, LUCAS DANIEL (PSYD)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:DANIEL
Last Name:DRISKELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HOWARD AVE.
Mailing Address - Street 2:YALE NEUROLOGY-YPB
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1369
Mailing Address - Country:US
Mailing Address - Phone:877-925-3637
Mailing Address - Fax:877-925-3329
Practice Address - Street 1:800 HOWARD AVE.
Practice Address - Street 2:YALE NEUROLOGY-YALE PHYSICIAN BUILDING
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:877-925-3637
Practice Address - Fax:877-925-3329
Is Sole Proprietor?:No
Enumeration Date:2018-06-17
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT3940103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program