Provider Demographics
NPI:1336223072
Name:LUCKER, SUSAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:LUCKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WESTLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTERN
Mailing Address - State:MA
Mailing Address - Zip Code:02493
Mailing Address - Country:US
Mailing Address - Phone:781-894-8898
Mailing Address - Fax:781-894-8898
Practice Address - Street 1:264 BEACON STREET
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:781-894-8898
Practice Address - Fax:781-894-8898
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105089104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03512OtherBLUE CROSS BLUE SHIELD
MAP03512OtherBLUE CROSS BLUE SHIELD