Provider Demographics
NPI:1891960985
Name:LUCIER-MUSTAFA, PENNY J (MED CCC A)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:J
Last Name:LUCIER-MUSTAFA
Suffix:
Gender:F
Credentials:MED CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724
Mailing Address - Country:US
Mailing Address - Phone:508-678-8336
Mailing Address - Fax:508-672-8724
Practice Address - Street 1:829 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 250
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724
Practice Address - Country:US
Practice Address - Phone:508-678-8336
Practice Address - Fax:508-672-8724
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP130AU231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist