Healthcare Provider Details

I. General information

NPI: 1679637466
Provider Name (Legal Business Name): LUCIEN LAURIER DUQUETTE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 02/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ENGLE ST STE 203
ENGLEWOOD NJ
07631-2920
US

IV. Provider business mailing address

90 COLUMBUS AVE
CLOSTER NJ
07624-2454
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-1224
  • Fax: 201-894-4720
Mailing address:
  • Phone: 201-894-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberSI02555
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberSI02555
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberSI02555
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberSI02555
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberSI02555
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberSI02555
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: