Healthcare Provider Details

I. General information

NPI: 1730400466
Provider Name (Legal Business Name): LUCIA ENICA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD
BEDFORD MA
01730-1114
US

IV. Provider business mailing address

9 BIRCH ST
BELMONT MA
02478-2335
US

V. Phone/Fax

Practice location:
  • Phone: 617-470-1653
  • Fax:
Mailing address:
  • Phone: 617-489-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number203362
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number203362
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: