1417253162 NPI number — MRS. MAGGIE REBECCA LUCIAN LMFT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417253162 NPI number — MRS. MAGGIE REBECCA LUCIAN LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCIAN
Provider First Name:
MAGGIE
Provider Middle Name:
REBECCA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

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:
1417253162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92 BLUEBERRY HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEWATER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06752-1340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-241-8333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
92 BLUEBERRY HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEWATER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06752-1340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-241-8333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2011

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: 106H00000X , with the licence number:  001623 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 060669107 . This is a "UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008050935 . This is a "HP MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "HEALTHYCT WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1270722 . This is a "CAQH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 539525 . This is a "MHN TRICARE NORTH- WELLMORE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "ANTHEM BCBS OF CT WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 539525 . This is a "MHN MANAGED HEALTH NETWORK-WELLMORE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1659821833 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5706769 . This is a "AETNA BEHAVIORAL HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4930108 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "UBH OXFORD LIBERTY/FREEDOM HEALTH WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "UBH-CONNECTICARE WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: D339209 . This is a "VALUE OPTIONS/BEACON HEALTH STRATEGIES" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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