Provider Demographics
NPI:1053606392
Name:LUCINDAS HAIR
Entity type:Organization
Organization Name:LUCINDAS HAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:HAIRSTYLIST
Authorized Official - Phone:203-272-1585
Mailing Address - Street 1:650 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2207
Mailing Address - Country:US
Mailing Address - Phone:203-272-1585
Mailing Address - Fax:203-272-2602
Practice Address - Street 1:650 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2207
Practice Address - Country:US
Practice Address - Phone:203-272-1585
Practice Address - Fax:203-272-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6706670001Medicare NSC