MEDICARE: NICOLE J LUCIANO LCDA

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	17402	PR

General Provider Information

NPI Number	:	1225990021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE J LUCIANO LCDA

Provider Business Mailing Address
First Line	:	W12 CALLE 27
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728-4485
Country	:	US
Telephone Number	:	939-216-8763
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB. LOS CAOBOS 2677 CALLE CLAVELINO
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716
Country	:	US
Telephone Number	:	939-216-8763
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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