MEDICARE: AMANDA N LUCAS LPC

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	101YP2500X	Professional Counselor	PC002898	PA

General Provider Information

NPI Number	:	1932317336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA N LUCAS LPC

Provider Business Mailing Address
First Line	:	1802 SANGATE DR
Second Line	:
City	:	SOUTH PARK
State	:	PA
Zip	:	15129-9209
Country	:	US
Telephone Number	:	412-759-8441
Fax Number	:

Provider Business Practice Location Address
First Line	:	3934 PERRYSVILLE AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15214-1748
Country	:	US
Telephone Number	:	412-931-8907
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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