Provider Demographics
NPI:1902137748
Name:TAYLOR, LUX MARIA (LCDP)
Entity Type:Individual
Prefix:MS
First Name:LUX
Middle Name:MARIA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-5917
Mailing Address - Country:US
Mailing Address - Phone:401-272-0660
Mailing Address - Fax:401-454-0195
Practice Address - Street 1:662 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-5917
Practice Address - Country:US
Practice Address - Phone:401-272-0660
Practice Address - Fax:401-454-0195
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP00196101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)