Healthcare Provider Details

I. General information

NPI: 1609709682
Provider Name (Legal Business Name): RACHELLE DELORVIL BURES-LUKACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2479 ALOMA AVE
WINTER PARK FL
32792-2541
US

IV. Provider business mailing address

2415 OLD SAINT AUGUSTINE RD
TALLAHASSEE FL
32301-4936
US

V. Phone/Fax

Practice location:
  • Phone: 407-657-6692
  • Fax: 407-894-6010
Mailing address:
  • Phone: 305-979-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: