Provider Demographics
NPI:1932430014
Name:LUCKER-GREENE, KIM DANIELLE (BCBA-D)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:DANIELLE
Last Name:LUCKER-GREENE
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8700 ROLLING BROOK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9024
Mailing Address - Country:US
Mailing Address - Phone:904-534-6935
Mailing Address - Fax:904-683-3670
Practice Address - Street 1:8700 ROLLING BROOK LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9024
Practice Address - Country:US
Practice Address - Phone:904-534-6935
Practice Address - Fax:904-683-3670
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst