MEDICARE: MRS. KIM E. LUCEY 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	L3676	OR

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	:	1972841054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIM E. LUCEY LCSW

Provider Business Mailing Address
First Line	:	1020 SW TAYLOR ST STE 700
Second Line	:	1125
City	:	PORTLAND
State	:	OR
Zip	:	97205-2512
Country	:	US
Telephone Number	:	971-225-0105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 SW TAYLOR ST STE 700
Second Line	:	1125
City	:	PORTLAND
State	:	OR
Zip	:	97205-2512
Country	:	US
Telephone Number	:	971-225-0105
Fax Number	:

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

Provider Enumeration Date	:	01/23/2013
Last Update Date	:	07/27/2016

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