Healthcare Provider Details

I. General information

NPI: 1144141326
Provider Name (Legal Business Name): BONNIE M LUCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 AVONDALE PL
SYRACUSE NY
13210-2510
US

IV. Provider business mailing address

200 IVY ST
BROOKLINE MA
02446-3907
US

V. Phone/Fax

Practice location:
  • Phone: 888-613-2777
  • Fax:
Mailing address:
  • Phone: 888-613-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number230894
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: