Provider Demographics
NPI:1902415375
Name:LUCIDO, LAURYN
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:
Last Name:LUCIDO
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 1:1452 26TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3042
Mailing Address - Country:US
Mailing Address - Phone:310-401-5072
Mailing Address - Fax:
Practice Address - Street 1:1452 26TH ST STE 106
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3042
Practice Address - Country:US
Practice Address - Phone:310-401-5072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120481106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist