Healthcare Provider Details

I. General information

NPI: 1740293463
Provider Name (Legal Business Name): LUCILLE A RADCLIFFE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHELMSFORD STREET
CHELSFORD MA
01824
US

IV. Provider business mailing address

201 CHELMSFORD ST
CHELMSFORD MA
01824-2307
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-1467
  • Fax:
Mailing address:
  • Phone: 978-256-1467
  • Fax: 978-256-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111477
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: