Provider Demographics
NPI:1902108178
Name:LUCAS, LINDA SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N US HIGHWAY 441 STE 1108
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6800
Mailing Address - Country:US
Mailing Address - Phone:352-205-7676
Mailing Address - Fax:352-205-8620
Practice Address - Street 1:1501 N US HIGHWAY 441 STE 1108
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6800
Practice Address - Country:US
Practice Address - Phone:352-205-7676
Practice Address - Fax:352-205-8620
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002889500Medicaid