Healthcare Provider Details

I. General information

NPI: 1730620022
Provider Name (Legal Business Name): LUCENT DEVELOPMENT AND BEHAVIOR SOLUTIONS, L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 WHITNEY ISLES DR
WINDERMERE FL
34786-6067
US

IV. Provider business mailing address

PO BOX 943
WINDERMERE FL
34786-0943
US

V. Phone/Fax

Practice location:
  • Phone: 850-240-5866
  • Fax:
Mailing address:
  • Phone: 850-240-5866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA MARIE WESSON
Title or Position: MGRM
Credential: BCBA
Phone: 850-240-5866