Healthcare Provider Details

I. General information

NPI: 1033397161
Provider Name (Legal Business Name): CYNTHIA LUCAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 BALDWIN ST UNIT 13
JENISON MI
49428-8937
US

IV. Provider business mailing address

7451 SANDYHILL DR
JENISON MI
49428-7774
US

V. Phone/Fax

Practice location:
  • Phone: 616-396-2972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL1122849
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: