Provider Demographics
NPI:1073773479
Name:LUCIANO, LISA M (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:LUCIANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 30TH ST
Mailing Address - Street 2:SUITE 440
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1022
Mailing Address - Country:US
Mailing Address - Phone:303-442-3755
Mailing Address - Fax:303-440-6463
Practice Address - Street 1:1790 30TH ST
Practice Address - Street 2:SUITE 440
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1022
Practice Address - Country:US
Practice Address - Phone:303-442-3755
Practice Address - Fax:303-440-6463
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health