MEDICARE: LAUREN LUCAS PHD P A

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	103T00000X	Psychologist	PY2701	FL

General Provider Information

NPI Number	:	1801851266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREN LUCAS PHD P A

Provider Business Mailing Address
First Line	:	3100 UNIVERSITY BLVD S
Second Line	:	SUITE 122
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2758
Country	:	US
Telephone Number	:	904-725-2008
Fax Number	:	904-725-8050

Provider Business Practice Location Address
First Line	:	3100 UNIVERSITY BLVD S
Second Line	:	SUITE 122
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2758
Country	:	US
Telephone Number	:	904-725-2008
Fax Number	:	904-725-8050

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. LAUREN LUCAS
Credential	:	PH.D.
Telephone Number	:	904-725-2008

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	01/24/2011

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