Provider Demographics
NPI:1457963118
Name:LUCAS, FREDERICKA (RHIT)
Entity type:Individual
Prefix:
First Name:FREDERICKA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RHIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14830 BAGLEY RD APT 205
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-5503
Mailing Address - Country:US
Mailing Address - Phone:216-322-2630
Mailing Address - Fax:
Practice Address - Street 1:398 W BAGLEY RD STE 216
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1312
Practice Address - Country:US
Practice Address - Phone:216-372-7009
Practice Address - Fax:440-815-2552
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health