Provider Demographics
NPI:1952544090
Name:LUCIA, BETH ANNE (LSW)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANNE
Last Name:LUCIA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2730
Mailing Address - Country:US
Mailing Address - Phone:609-267-5656
Mailing Address - Fax:609-267-8892
Practice Address - Street 1:218A SUNSET RD
Practice Address - Street 2:SCREENING, CRISIS & INTERVENTION PROGRAM (SCIP)
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1110
Practice Address - Country:US
Practice Address - Phone:609-835-6180
Practice Address - Fax:609-835-7962
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-18
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL04591200101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ174400000XOtherBEHAVIORAL HEALTH SERVICES