1821159161 NPI number — MR. SALVATORE J LUCCA

Table of content: MR. SALVATORE J LUCCA (NPI 1821159161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821159161 NPI number — MR. SALVATORE J LUCCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCCA
Provider First Name:
SALVATORE
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821159161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 WIDGEON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST YARMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02673-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-776-9251
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
572 ROUTE 28
Provider Second Line Business Practice Location Address:
PARE & ASSOCIATES
Provider Business Practice Location Address City Name:
WEST YARMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02673-4909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-775-0777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  217612 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 217612 . This is a "CLINICAL MENTAL HEALTH CO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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