Provider Demographics
NPI:1922209279
Name:LUCK, MARIANNA M
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:M
Last Name:LUCK
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 1:857 CHANDLEE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-1979
Mailing Address - Country:US
Mailing Address - Phone:610-692-7088
Mailing Address - Fax:610-692-0876
Practice Address - Street 1:710 S BRANDYWINE ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-3511
Practice Address - Country:US
Practice Address - Phone:610-692-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005833-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0536119000OtherMHS PROVIDER NO.