Provider Demographics
NPI:1245969492
Name:LUCIER, ELISHA RENEE (LPN,RBT)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:RENEE
Last Name:LUCIER
Suffix:
Gender:F
Credentials:LPN,RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 MORRISON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1529
Mailing Address - Country:US
Mailing Address - Phone:937-723-0841
Mailing Address - Fax:
Practice Address - Street 1:581 MORRISON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44904-1529
Practice Address - Country:US
Practice Address - Phone:937-723-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-22-205641106S00000X
OHPN-109523164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN-109523OtherLPN
OHRBT-22-205641OtherREGISTERED BEHAVIOR TECHNICIAN