Individual
EDWARD BOSEMAN LUCKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
812 N 65TH ST, PHILA, PA 19151-3303
(215) 284-7210
Mailing address
812 N 65TH ST, PHILA, PA 19151-3303
(215) 284-7210
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH001931
PA
Other
Enumeration date
11/04/2014
Last updated
11/04/2014
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