1457429334 NPI number — JEAN L LUKENS M.S.W., LICSW

Table of content: JEAN L LUKENS M.S.W., LICSW (NPI 1457429334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457429334 NPI number — JEAN L LUKENS M.S.W., LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUKENS
Provider First Name:
JEAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.W., LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457429334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 N LEVERETT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEVERETT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01054-9735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-695-3242
Provider Business Mailing Address Fax Number:
413-253-9000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
664 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE #56
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01002-2439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-695-3242
Provider Business Practice Location Address Fax Number:
413-253-9000
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  105226 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 160478 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1853864 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 460355 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 105226 . This is a "LICSW LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P04156 . This is a "BLUE CROSS SHIELD OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11353 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 32398 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 556232 . This is a "MAGELLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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