Healthcare Provider Details

I. General information

NPI: 1689716672
Provider Name (Legal Business Name): SUZANNE R. LUCOT MD PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 UNIONVILLE RD SUITE 175
CRANBERRY TOWNSHIP PA
16066-3415
US

IV. Provider business mailing address

3104 UNIONVILLE RD SUITE 175
CRANBERRY TOWNSHIP PA
16066-3415
US

V. Phone/Fax

Practice location:
  • Phone: 724-776-3366
  • Fax: 724-776-3367
Mailing address:
  • Phone: 724-776-3366
  • Fax: 724-776-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMD060218L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUZANNE REICHLE LUCOT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 724-776-3366