1912191933 NPI number — MS. BERNADINE CORINNE LUCKEY LCSW

Table of content: MS. BERNADINE CORINNE LUCKEY LCSW (NPI 1912191933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912191933 NPI number — MS. BERNADINE CORINNE LUCKEY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCKEY
Provider First Name:
BERNADINE
Provider Middle Name:
CORINNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1912191933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 410994
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94141-0994
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-653-2214
Provider Business Mailing Address Fax Number:
510-601-9846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6221 GEARY BLVD
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94121-1887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-558-8177
Provider Business Practice Location Address Fax Number:
415-558-8258
Provider Enumeration Date:
09/03/2007

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:  LCS 24035 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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