Provider Demographics
NPI:1780362517
Name:STONE-RILEY, LU'CKETT DEAN
Entity type:Individual
Prefix:
First Name:LU'CKETT
Middle Name:DEAN
Last Name:STONE-RILEY
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 1:38 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4604
Mailing Address - Country:US
Mailing Address - Phone:774-517-7790
Mailing Address - Fax:617-773-3145
Practice Address - Street 1:38 BROAD ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4604
Practice Address - Country:US
Practice Address - Phone:774-517-7790
Practice Address - Fax:617-773-3145
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator