MEDICARE: CHRISTINE LUCAS LCSW-C

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	18565	MD

General Provider Information

NPI Number	:	1073967006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE LUCAS LCSW-C

Provider Business Mailing Address
First Line	:	5526 LANHAM WAY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-3027
Country	:	US
Telephone Number	:	410-790-4501
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 N CHARLES ST STE 1400
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-3728
Country	:	US
Telephone Number	:	410-254-6175
Fax Number	:

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

Provider Enumeration Date	:	04/15/2016
Last Update Date	:	04/15/2016

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