MEDICARE: MS. LUCY PRIEST 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	005413	CT

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

General Provider Information

NPI Number	:	1639282247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LUCY PRIEST LCSW

Provider Business Mailing Address
First Line	:	11 MAIN ST
Second Line	:	OLD MILL SUITE 8
City	:	MYSTIC
State	:	CT
Zip	:	06355-3654
Country	:	US
Telephone Number	:	860-572-4995
Fax Number	:	860-572-4987

Provider Business Practice Location Address
First Line	:	11 MAIN ST
Second Line	:	OLD MILL SUITE 8
City	:	MYSTIC
State	:	CT
Zip	:	06355-3654
Country	:	US
Telephone Number	:	860-572-4995
Fax Number	:	860-572-4987

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/01/2008

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Directions to “ MS. LUCY PRIEST LCSW” Practice Location

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