Active NPI
Mark Leon Lucyk, PH.D.
- Clinical Psychologist
- West Hartford, CT
National Provider Identifier
1386737450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- CT001405
- Practice address
- 10 North Main Street
Suite 204
West Hartford, CT 06107-1968 - Phone
- (860) 561-2400
- NPI assigned
- Oct 2, 2006
- Last updated
- Nov 21, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1405CT01 | CT | |
| Clinical Psychologist | 103TC0700X | CT001405 | CT | Primary |
Addresses
Primary practice location
10 North Main Street
Suite 204
West Hartford, CT 06107-1968
Mailing address
10 North Main Street
Suite 204
West Hartford, CT 06107-1968
Phone (860) 561-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 26, 2023 through Jul 26, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1405CT01 | CT | MD | Clinical Psychologist |
| CT001405 | CT | MD | Clinical Psychologist |
| 001405 | CT | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700524800000",
"number": "1386737450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 NORTH MAIN STREET",
"address_2": "SUITE 204",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061071968",
"telephone_number": "860-561-2400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 NORTH MAIN STREET",
"address_2": "SUITE 204",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061071968",
"telephone_number": "860-561-2400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCYK",
"first_name": "MARK",
"middle_name": "LEON",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2023-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "1405CT01",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "CT001405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.