Provider Demographics
NPI:1013624618
Name:LUMATE FLORIDA INC
Entity Type:Organization
Organization Name:LUMATE FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-304-0679
Mailing Address - Street 1:822 GUILFORD AVE # 1500
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3707
Mailing Address - Country:US
Mailing Address - Phone:800-402-8768
Mailing Address - Fax:
Practice Address - Street 1:3151 CATRINA LN
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-4343
Practice Address - Country:US
Practice Address - Phone:917-304-0679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty