Provider Demographics
NPI:1356387104
Name:LUCENTE, STEPHEN WILLIAM
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:LUCENTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 STABLE RD
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-4144
Mailing Address - Country:US
Mailing Address - Phone:443-995-9814
Mailing Address - Fax:
Practice Address - Street 1:1502 W NC HIGHWAY 54
Practice Address - Street 2:SUITE 103
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5571
Practice Address - Country:US
Practice Address - Phone:919-403-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3314103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical