MEDICARE: LUCENTRA CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1053100610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCENTRA CARE, LLC

Provider Business Mailing Address
First Line	:	7903 ORION CIR UNIT 340
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-3111
Country	:	US
Telephone Number	:	301-265-6441
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 ELLICOTT CENTER DR STE 205
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4667
Country	:	US
Telephone Number	:	301-265-6441
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ALI MOHAMMADABADI
Credential	:
Telephone Number	:	301-265-6441

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	07/18/2025

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