Provider Demographics
NPI:1962764274
Name:LUCKY, CARLIN BRANDON (DO)
Entity type:Individual
Prefix:DR
First Name:CARLIN
Middle Name:BRANDON
Last Name:LUCKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4805
Mailing Address - Country:US
Mailing Address - Phone:978-728-4957
Mailing Address - Fax:978-798-1366
Practice Address - Street 1:1069 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4805
Practice Address - Country:US
Practice Address - Phone:978-728-4957
Practice Address - Fax:978-798-1366
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2907242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry