Provider Demographics
NPI:1932655354
Name:LUCAS, KAYLA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MARIE
Other - Last Name:FRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2446 WHITNEY AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3233
Mailing Address - Country:US
Mailing Address - Phone:203-298-9005
Mailing Address - Fax:203-535-0023
Practice Address - Street 1:1 BRADLEY RD STE 404405
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2285
Practice Address - Country:US
Practice Address - Phone:203-298-9005
Practice Address - Fax:203-298-9453
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0092931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical