Healthcare Provider Details

I. General information

NPI: 1366352601
Provider Name (Legal Business Name): ALEKSANDAR LUCIC LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 S LAKESHORE DR STE 6
TEMPE AZ
85282-7152
US

IV. Provider business mailing address

515 W 10TH ST
TEMPE AZ
85281-5513
US

V. Phone/Fax

Practice location:
  • Phone: 602-774-4745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-23440
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: