Provider Demographics
NPI:1699129544
Name:LUKIC, BORIS
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:LUKIC
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 1:11 LAWRENCE ST STE 303
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1436
Mailing Address - Country:US
Mailing Address - Phone:978-965-9176
Mailing Address - Fax:
Practice Address - Street 1:599 CANAL ST
Practice Address - Street 2:5TH FLOOR, WEST SUITE #12
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1244
Practice Address - Country:US
Practice Address - Phone:978-989-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health