Doctor Name: | NELSON LUCCA |
NPI Number: | 1922213743 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.ED.,RMHC |
License Number: | IMH6055 |
Business Practice Address: | 237 Fernwood Blvd Fern Park, FL - 327302116 |
Business Phone Number: | 4078312411 |
Business Fax Number: | |
Mailing Address: | 19414 Briercrest Trl, ORLANDO |
State: | FL |
Postal Code: | 328335525 |
Phone Number: | 4078312411 |
Fax Number: | |
NPI Enumeration Date: | 05/14/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | IMH6055 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |