Provider Demographics
NPI:1982811485
Name:LUCAS, CAROL A (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 COUNTRY LAKE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5094
Mailing Address - Country:US
Mailing Address - Phone:631-774-8653
Mailing Address - Fax:516-877-3139
Practice Address - Street 1:1 SOUTH AVE
Practice Address - Street 2:UNIVERSITY CENTER ROOM 310
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4213
Practice Address - Country:US
Practice Address - Phone:631-774-8653
Practice Address - Fax:516-877-3139
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066727-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN598H1Medicare UPIN