Healthcare Provider Details

I. General information

NPI: 1801851266
Provider Name (Legal Business Name): LAUREN LUCAS PHD P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 UNIVERSITY BLVD S SUITE 122
JACKSONVILLE FL
32216-2758
US

IV. Provider business mailing address

3100 UNIVERSITY BLVD S SUITE 122
JACKSONVILLE FL
32216-2758
US

V. Phone/Fax

Practice location:
  • Phone: 904-725-2008
  • Fax: 904-725-8050
Mailing address:
  • Phone: 904-725-2008
  • Fax: 904-725-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY2701
License Number StateFL

VIII. Authorized Official

Name: DR. LAUREN LUCAS
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 904-725-2008