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General NPI Number Information
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NPI Number | 1932910841
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Entity Type | Individual
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Provider Name | KERRY LUCAS LPC
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 111 HOWARD BLVD STE 204-205
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City | MOUNT ARLINGTON
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State | NJ
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Zip | 07856-1315
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Country | US
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Telephone | 973-601-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 15 RIDGE RD
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City | STANHOPE
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State | NJ
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Zip | 07874-2858
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Country | US
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Telephone | 862-419-5092
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC01096800
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License Number State | NJ
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