Provider Demographics
NPI:1831401124
Name:LUCICH, PAUL HAMILTON (LMFT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:HAMILTON
Last Name:LUCICH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 WARWICK AVE REAR UNIT
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3547
Mailing Address - Country:US
Mailing Address - Phone:401-383-2200
Mailing Address - Fax:401-256-5209
Practice Address - Street 1:1087 WARWICK AVE REAR UNIT
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3547
Practice Address - Country:US
Practice Address - Phone:401-383-2200
Practice Address - Fax:401-256-5209
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMFT00198106H00000X
CAIMF 63132106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist