Provider Demographics
NPI:1770645186
Name:LUCIDO, GRACE MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:MARIE
Last Name:LUCIDO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:M
Other - Last Name:LUCIDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT MA
Mailing Address - Street 1:19 TERRACE DR.
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-343-0626
Mailing Address - Fax:
Practice Address - Street 1:630 SALEM ST SUITE 210
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-343-0626
Practice Address - Fax:530-879-3325
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28219101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist