Active NPI
Carlin Brandon Lucky, D.O.
- Psychiatry Physician
- Leominster, MA
National Provider Identifier
1962764274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 290724
- Practice address
- 1069 Central St
Leominster, MA 01453-4805 - Phone
- (978) 728-4957
- Fax
- (978) 798-1366
- NPI assigned
- Jun 12, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 290724 | MA | Primary |
Addresses
Primary practice location
1069 Central St
Leominster, MA 01453-4805
Mailing address
1069 Central St
Leominster, MA 01453-4805
Phone (978) 728-4957
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 290724 | MA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Neuroscience Services, LLC | Psychiatry | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/IJCCDA
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": "1339459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663891200000",
"number": "1962764274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1069 CENTRAL ST",
"city": "LEOMINSTER",
"state": "MA",
"postal_code": "014534805",
"telephone_number": "978-728-4957",
"fax_number": "978-798-1366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1069 CENTRAL ST",
"city": "LEOMINSTER",
"state": "MA",
"postal_code": "014534805",
"telephone_number": "978-728-4957",
"fax_number": "978-798-1366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCKY",
"first_name": "CARLIN",
"middle_name": "BRANDON",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-12",
"last_updated": "2022-09-23",
"certification_date": "2022-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "290724",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leominster, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.