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General NPI Number Information
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NPI Number | 1922209279
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Entity Type | Individual
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Provider Name | MARIANNA M. LUCK
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 710 S BRANDYWINE ST
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City | WEST CHESTER
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State | PA
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Zip | 19382-3511
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Country | US
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Telephone | 610-692-3456
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Fax |
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Provider Business Mailing Address
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Address Line | 857 CHANDLEE DR
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City | WEST CHESTER
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State | PA
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Zip | 19382-1979
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Country | US
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Telephone | 610-692-7088
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Fax | 610-692-0876
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS-005833-L
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License Number State | PA
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