Provider Demographics
NPI:1104955772
Name:LUCET, CAROLYN R (MSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:R
Last Name:LUCET
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:EATON CENTER
Mailing Address - State:NH
Mailing Address - Zip Code:03832-0234
Mailing Address - Country:US
Mailing Address - Phone:603-387-6805
Mailing Address - Fax:603-356-7975
Practice Address - Street 1:47 WASHINGTON ST
Practice Address - Street 2:SUITE #2
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6057
Practice Address - Country:US
Practice Address - Phone:603-387-6805
Practice Address - Fax:603-356-7975
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010703Medicaid
NH30010703Medicaid