Provider Demographics
NPI:1184969024
Name:LUCIEN, MARIE ROSE (TEACHER)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ROSE
Last Name:LUCIEN
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 EMILY AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4219
Mailing Address - Country:US
Mailing Address - Phone:516-354-1051
Mailing Address - Fax:
Practice Address - Street 1:51 EMILY AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4219
Practice Address - Country:US
Practice Address - Phone:516-354-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069058011174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist