Healthcare Provider Details

I. General information

NPI: 1225990021
Provider Name (Legal Business Name): NICOLE J LUCIANO LCDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. LOS CAOBOS 2677 CALLE CLAVELINO
PONCE PR
00716
US

IV. Provider business mailing address

W12 CALLE 27
PONCE PR
00728-4485
US

V. Phone/Fax

Practice location:
  • Phone: 939-216-8763
  • Fax:
Mailing address:
  • Phone: 939-216-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17402
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: