=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063507911
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA LUCAS MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 10/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205B S DUFFY RD STE 2
-----------------------------------------------------
City | BUTLER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16001-2708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-256-9881
-----------------------------------------------------
Fax | 724-256-9883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 S JEFFERSON ST
-----------------------------------------------------
City | KITTANNING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16201-2416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-545-4540
-----------------------------------------------------
Fax | 724-548-8119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW014419
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------