Provider Demographics
NPI:1780291278
Name:GRACE, LUCY FLORENCE (M ED)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:FLORENCE
Last Name:GRACE
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:FLORENCE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EVANS
Mailing Address - Street 1:89 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1322
Mailing Address - Country:US
Mailing Address - Phone:781-888-5736
Mailing Address - Fax:
Practice Address - Street 1:40 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-6113
Practice Address - Country:US
Practice Address - Phone:781-888-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X, 101YP2500X
MA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAEINMedicaid
MA1780291278Medicaid