MEDICARE: STACY L. COOPER LUCIDO M.ED. CCC-SLP

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	235Z00000X	Speech-Language Pathologist	4438	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	SP0184	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1245383983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY L. COOPER LUCIDO M.ED. CCC-SLP

Provider Business Mailing Address
First Line	:	13 SUNSET DR
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-2319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 CUMMINGS CTR
Second Line	:	SUITE 3850
City	:	BEVERLY
State	:	MA
Zip	:	01915-6142
Country	:	US
Telephone Number	:	978-232-0332
Fax Number	:	978-232-1103

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/31/2008

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Directions to “ STACY L. COOPER LUCIDO M.ED. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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