Provider Demographics
NPI:1144450628
Name:MARIA A LUCCHESI PHD PA
Entity type:Organization
Organization Name:MARIA A LUCCHESI PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUCCHESI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-867-6856
Mailing Address - Street 1:2863 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3645
Mailing Address - Country:US
Mailing Address - Phone:305-867-6856
Mailing Address - Fax:305-397-1523
Practice Address - Street 1:2863 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 106
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3645
Practice Address - Country:US
Practice Address - Phone:305-867-6856
Practice Address - Fax:305-397-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty