Provider Demographics
NPI:1386737450
Name:LUCYK, MARK LEON (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEON
Last Name:LUCYK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1968
Mailing Address - Country:US
Mailing Address - Phone:860-561-2400
Mailing Address - Fax:
Practice Address - Street 1:10 NORTH MAIN STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1968
Practice Address - Country:US
Practice Address - Phone:860-561-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1405CT01103TC0700X
CTCT001405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical