Provider Demographics
NPI:1245831239
Name:MCKITTRICK, LUCAS M (MA, EDS)
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:M
Last Name:MCKITTRICK
Suffix:
Gender:M
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1091
Mailing Address - Country:US
Mailing Address - Phone:603-448-2055
Mailing Address - Fax:603-448-1356
Practice Address - Street 1:195 HANOVER ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1091
Practice Address - Country:US
Practice Address - Phone:603-448-2055
Practice Address - Fax:603-448-1356
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH94411103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH94411OtherNH DEPARTMENT OF EDUCATION