1780291278 NPI number — LUCY FLORENCE GRACE M. ED

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 1780291278 NPI number — LUCY FLORENCE GRACE M. ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRACE
Provider First Name:
LUCY
Provider Middle Name:
FLORENCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M. ED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVANS
Provider Other First Name:
LUCY
Provider Other Middle Name:
FLORENCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
EVANS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780291278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 WHITNEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01850-1322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-888-5736
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01852-6113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-888-5736
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2020

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: EIN , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1780291278 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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