Provider Demographics
NPI:1013002302
Name:LUKASAVAGE, FRANK P (LISW, LCSW, LADAC)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:P
Last Name:LUKASAVAGE
Suffix:
Gender:M
Credentials:LISW, LCSW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3566
Mailing Address - Street 2:
Mailing Address - City:MORIARTY
Mailing Address - State:NM
Mailing Address - Zip Code:87035-3566
Mailing Address - Country:US
Mailing Address - Phone:505-891-1001
Mailing Address - Fax:
Practice Address - Street 1:2010 33RD AVENUE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144
Practice Address - Country:US
Practice Address - Phone:505-891-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3831101YA0400X
NM20811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201012186OtherPRESBYTERIAN BEHAVIORAL H
NM100343Medicaid