Provider Demographics
NPI:1922267343
Name:LUCAS, DIANE M (LCSW-R)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 N CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-1455
Mailing Address - Country:US
Mailing Address - Phone:585-262-7035
Mailing Address - Fax:585-770-1116
Practice Address - Street 1:87 N CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-1455
Practice Address - Country:US
Practice Address - Phone:585-262-7035
Practice Address - Fax:585-770-1116
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO46228-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical