Individual
MR. PHILLIP JASON LUCIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAS, CASAC
Contact information
Practice address
636 NEW LOUDON RD, LATHAM, NY 12110-4002
(518) 783-5381
Mailing address
21 WOODLAKE RD, APT # 2, ALBANY, NY 12203-3977
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25740
NY
172V00000X
Community Health Worker
25740
NY
Other
Enumeration date
10/02/2012
Last updated
08/17/2022
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