Provider Demographics
NPI:1366278921
Name:LUCIOUS CONWAY SOCIAL SECURITY DISABILITY ADVOCATES
Entity type:Organization
Organization Name:LUCIOUS CONWAY SOCIAL SECURITY DISABILITY ADVOCATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUCIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-454-4492
Mailing Address - Street 1:7418 PURITAN ST APT 103
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-1200
Mailing Address - Country:US
Mailing Address - Phone:347-454-4492
Mailing Address - Fax:
Practice Address - Street 1:7418 PURITAN ST APT 103
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1200
Practice Address - Country:US
Practice Address - Phone:347-454-4492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty