Provider Demographics
NPI:1942707294
Name:LACERDA, LUCAS ROCHA
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:ROCHA
Last Name:LACERDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 PARK VILLA PL
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-5211
Mailing Address - Country:US
Mailing Address - Phone:619-802-3038
Mailing Address - Fax:888-308-9656
Practice Address - Street 1:916 PARK VILLA PL
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-5211
Practice Address - Country:US
Practice Address - Phone:619-802-3038
Practice Address - Fax:888-308-9656
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst