Healthcare Provider Details

I. General information

NPI: 1497295687
Provider Name (Legal Business Name): LUCAS ENGLISH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 RUSSELL RD
PAOLI PA
19301-1236
US

IV. Provider business mailing address

680 AMERICAN AVE SUITE 302
KING OF PRUSSIA PA
19406-4023
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6464
  • Fax: 610-981-6078
Mailing address:
  • Phone: 610-644-6464
  • Fax: 610-981-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW132028
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: