Provider Demographics
NPI:1699524488
Name:KILLAM, LUCIANA M
Entity type:Individual
Prefix:
First Name:LUCIANA
Middle Name:M
Last Name:KILLAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81A KEMP ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1125
Mailing Address - Country:US
Mailing Address - Phone:978-328-3105
Mailing Address - Fax:
Practice Address - Street 1:81A KEMP ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1125
Practice Address - Country:US
Practice Address - Phone:978-328-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty