Healthcare Provider Details

I. General information

NPI: 1669337291
Provider Name (Legal Business Name): DESIREE LUCAS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N CENTER ST
CORRY PA
16407-1625
US

IV. Provider business mailing address

150 N CENTER ST
CORRY PA
16407-1625
US

V. Phone/Fax

Practice location:
  • Phone: 814-250-1814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS019824
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: