Provider Demographics
NPI:1336563220
Name:LUCAS, ANITA (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 ENRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2270
Mailing Address - Country:US
Mailing Address - Phone:937-259-6620
Mailing Address - Fax:
Practice Address - Street 1:5555 ENRIGHT AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:OH
Practice Address - Zip Code:45431-2270
Practice Address - Country:US
Practice Address - Phone:937-259-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00259821041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool