Provider Demographics
NPI:1770990632
Name:HOLOHAN, LUCINDA KAREN
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:KAREN
Last Name:HOLOHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUCINDA
Other - Middle Name:K
Other - Last Name:HOLOHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:2138 SW JANETTE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1005
Mailing Address - Country:US
Mailing Address - Phone:772-521-4463
Mailing Address - Fax:772-871-0186
Practice Address - Street 1:772 CRYSTAL MIST AVE
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-6145
Practice Address - Country:US
Practice Address - Phone:772-521-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst