Provider Demographics
NPI:1306127972
Name:LUCCASEN, RAPHEAL
Entity type:Individual
Prefix:
First Name:RAPHEAL
Middle Name:
Last Name:LUCCASEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-2822
Mailing Address - Country:US
Mailing Address - Phone:713-528-2328
Mailing Address - Fax:
Practice Address - Street 1:3007 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-2822
Practice Address - Country:US
Practice Address - Phone:713-528-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1487C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical