MEDICARE: MS. LAURIE T LUCAS LCSW

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	1041C0700X	Clinical Social Worker	LCS 14022	CA

General Provider Information

NPI Number	:	1114910288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE T LUCAS LCSW

Provider Business Mailing Address
First Line	:	901 DOVE ST
Second Line	:	STE 295
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-3036
Country	:	US
Telephone Number	:	949-640-4674
Fax Number	:	949-769-3974

Provider Business Practice Location Address
First Line	:	1151 DOVE ST
Second Line	:	SUITE 105
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2840
Country	:	US
Telephone Number	:	949-640-4674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	09/20/2017

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