Individual provider Active NPI

Phillip Jason Lucien, CAS, CASAC

  • Addiction (Substance Use Disorder) Counselor
  • Latham, NY
National Provider Identifier
1619228582
Registry record updated Aug 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
25740 Issued in NY
Practice address
636 New Loudon Rd
Latham, NY 12110-4002
Phone
(518) 783-5381
NPI assigned
Oct 2, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 25740 NY Primary
Community Health Worker 172V00000X 25740 NY

Addresses

Primary practice location

636 New Loudon Rd
Latham, NY 12110-4002

Mailing address

21 Woodlake Rd
Apt # 2
Albany, NY 12203-3977

Other practice location 1

600 Franklin St Ste 204
Schenectady, NY 12305-2100
Phone (518) 372-7031

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
25740NYMDCommunity Health Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Conifer Park, Inc. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660694400000",
    "number": "1619228582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 WOODLAKE RD",
            "address_2": "APT # 2",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122033977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 NEW LOUDON RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121104002",
            "telephone_number": "518-783-5381"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Franklin St Ste 204",
            "address_purpose": "LOCATION",
            "city": "Schenectady",
            "state": "NY",
            "postal_code": "123052100",
            "country_code": "US",
            "telephone_number": "518-372-7031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUCIEN",
        "first_name": "PHILLIP",
        "middle_name": "JASON",
        "name_prefix": "Mr.",
        "credential": "CAS, CASAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-02",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "25740",
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NY",
            "license": "25740",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Latham, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.