MEDICARE: MADELINE LUCAS L.M.H.C.

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	101YM0800X	Mental Health Counselor	MH 7137	FL

General Provider Information

NPI Number	:	1588861033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE LUCAS L.M.H.C.

Provider Business Mailing Address
First Line	:	2450 NE 135TH ST
Second Line	:	# 104
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-3597
Country	:	US
Telephone Number	:	305-877-8821
Fax Number	:	305-947-3313

Provider Business Practice Location Address
First Line	:	1770 SANS SOUCI BLVD
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-3206
Country	:	US
Telephone Number	:	305-877-8821
Fax Number	:	305-947-3313

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

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	07/08/2007

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