Healthcare Provider Details

I. General information

NPI: 1902021942
Provider Name (Legal Business Name): ROSA E LUCIO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E DAKOTA AVE
FRESNO CA
93726-4821
US

IV. Provider business mailing address

PO BOX 2185
CLOVIS CA
93613-2185
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-7179
  • Fax:
Mailing address:
  • Phone: 831-578-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number43270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: