Provider Demographics
NPI:1306340674
Name:MOSCINSKI, LUCAS CANE
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:CANE
Last Name:MOSCINSKI
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 1:2516 A ST.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2111
Mailing Address - Country:US
Mailing Address - Phone:619-235-0592
Mailing Address - Fax:619-235-0593
Practice Address - Street 1:2516 A ST.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2111
Practice Address - Country:US
Practice Address - Phone:619-235-0592
Practice Address - Fax:619-235-0593
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)