Provider Demographics
NPI:1104494772
Name:VENESSA LUCK, MA, PLC
Entity type:Organization
Organization Name:VENESSA LUCK, MA, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST- MASTERS
Authorized Official - Prefix:
Authorized Official - First Name:VENESSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:802-829-8922
Mailing Address - Street 1:16 MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3565
Mailing Address - Country:US
Mailing Address - Phone:802-829-8922
Mailing Address - Fax:
Practice Address - Street 1:133 BLAKELY RD STE 206
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3984
Practice Address - Country:US
Practice Address - Phone:802-829-8922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty