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Individual
DR. SUSAN MARIE LUCK
Active
Individual
DR. SUSAN MARIE LUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., D. MIN., LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
72 049861
NY
1041C0700X
Clinical Social Worker
Primary
0904008785
VA
1041C0700X
Clinical Social Worker
73078744
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078744-1
LCSW NEW YORK LICENSE
NY
01
—
0904008785
LCSW LICENSE
VA
Enumeration date
12/03/2008
Last updated
09/05/2019
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