Healthcare Provider Details

I. General information

NPI: 1316488158
Provider Name (Legal Business Name): LUCIA DI PRIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W LOWRY LN STE 104
LEXINGTON KY
40503-3012
US

IV. Provider business mailing address

1118 COOPER DR APT 2
LEXINGTON KY
40502-2538
US

V. Phone/Fax

Practice location:
  • Phone: 185-947-5430
  • Fax:
Mailing address:
  • Phone: 256-572-7807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: