Provider Demographics
NPI:1922665330
Name:JANIS E LUCKY LLC
Entity Type:Organization
Organization Name:JANIS E LUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LUCKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS,NCC,LPC
Authorized Official - Phone:203-537-0542
Mailing Address - Street 1:410 STATE ST RM 5
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 STATE ST RM 5
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3149
Practice Address - Country:US
Practice Address - Phone:203-747-8230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760583496OtherINSURANCES
CT1760583496Medicaid