MEDICARE: MRS. CYNTHIA LUCAS LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L1122849	MI

General Provider Information

NPI Number	:	1033397161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA LUCAS LMSW

Provider Business Mailing Address
First Line	:	7451 SANDYHILL DR
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7774
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1346 BALDWIN ST UNIT 13
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-8937
Country	:	US
Telephone Number	:	616-396-2972
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/22/2024

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