Healthcare Provider Details

I. General information

NPI: 1598674285
Provider Name (Legal Business Name): LUCAS P FRAVEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 BROOK ST # 169
ROCKY HILL CT
06067-3463
US

IV. Provider business mailing address

169 WOODLAND DR # 169
CROMWELL CT
06416-1162
US

V. Phone/Fax

Practice location:
  • Phone: 877-612-7834
  • Fax:
Mailing address:
  • Phone: 860-990-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: