Provider Demographics
NPI:1225476757
Name:LUKON, GEORGE NEAL (RN)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:NEAL
Last Name:LUKON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HILLMONT AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1647
Mailing Address - Country:US
Mailing Address - Phone:805-652-6729
Mailing Address - Fax:
Practice Address - Street 1:1040 WALTHAM ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8033
Practice Address - Country:US
Practice Address - Phone:781-862-3600
Practice Address - Fax:781-860-0589
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
MARN2276803163WP0808X
CA95083829163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303287OtherMBHP
MA1004745OtherNHP
MA99618201OtherNETWORK HEALTH
MAM18633OtherBCBS
MA1303287Medicaid
MA0000023532OtherBMC
MA042611055OtherTAX ID
MA042611055OtherTAX ID