Healthcare Provider Details

I. General information

NPI: 1558660324
Provider Name (Legal Business Name): JENNIFER LUCARELLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER GAPINSKI

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 03/21/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 ROSEMARY ST, ENTRY K
NEEDHAM MA
02494
US

IV. Provider business mailing address

145 ROSEMARY ST, ENTRY K
NEEDHAM MA
02494
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-7186
  • Fax:
Mailing address:
  • Phone: 781-444-7186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number258140
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number258140
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110122649A
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: