Provider Demographics
NPI:1659496313
Name:LUCASH, RYAN EMILY (PHD)
Entity type:Individual
Prefix:MRS
First Name:RYAN
Middle Name:EMILY
Last Name:LUCASH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:RYAN
Other - Middle Name:EMILY
Other - Last Name:FUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:750 WELCH RD
Mailing Address - Street 2:DEVELOPMENTAL-BEHAVIORAL PEDIATRICS OFFICE
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1507
Mailing Address - Country:US
Mailing Address - Phone:650-725-8995
Mailing Address - Fax:
Practice Address - Street 1:750 WELCH RD
Practice Address - Street 2:DEVELOPMENTAL-BEHAVIORAL PEDIATRICS OFFICE
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1507
Practice Address - Country:US
Practice Address - Phone:650-725-8995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25960103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical