Provider Demographics
NPI:1447368691
Name:LUCAS, SUZANNE (RNCS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-1912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 AYER RD
Practice Address - Street 2:SHAKER PLACE SUITE 2
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1131
Practice Address - Country:US
Practice Address - Phone:978-772-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173379364S00000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA364051OtherMAGELLAN
MA456267OtherTUFTS
MA1858939Medicaid
MAPN0796OtherBLUECROSS
MA1858939Medicaid