Provider Demographics
NPI:1023159415
Name:LUCAS, LAUREN (PHD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:LUCAS
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3100 UNIVERSITY BLVD S
Mailing Address - Street 2:#122
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 UNIVERSITY BLVD S
Practice Address - Street 2:#122
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2758
Practice Address - Country:US
Practice Address - Phone:904-725-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2701103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
74358Medicare ID - Type Unspecified
FLR04063Medicare UPIN