Provider Demographics
NPI:1457888406
Name:SZASZ, LUCIETTE
Entity Type:Individual
Prefix:
First Name:LUCIETTE
Middle Name:
Last Name:SZASZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22949 OLD INLET BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6205
Mailing Address - Country:US
Mailing Address - Phone:561-305-4346
Mailing Address - Fax:
Practice Address - Street 1:22949 OLD INLET BRIDGE DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-6205
Practice Address - Country:US
Practice Address - Phone:561-305-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-20
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-00641106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty