Healthcare Provider Details

I. General information

NPI: 1104758648
Provider Name (Legal Business Name): LUCIA TERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S 11TH ST
NEW HYDE PARK NY
11040-5559
US

IV. Provider business mailing address

310 S 11TH ST
NEW HYDE PARK NY
11040-5559
US

V. Phone/Fax

Practice location:
  • Phone: 516-439-9360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: