Provider Demographics
NPI:1275358475
Name:PLAZA IDROVO, LUCIA CRISTINA (LAC)
Entity type:Individual
Prefix:MISS
First Name:LUCIA
Middle Name:CRISTINA
Last Name:PLAZA IDROVO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1419
Mailing Address - Country:US
Mailing Address - Phone:908-642-9449
Mailing Address - Fax:
Practice Address - Street 1:703 E VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1419
Practice Address - Country:US
Practice Address - Phone:908-642-9449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00698600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty