Provider Demographics
NPI:1326385683
Name:LUGO, LETICIA (CASAC-T)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:LUGO
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4516
Mailing Address - Country:US
Mailing Address - Phone:212-864-4128
Mailing Address - Fax:212-864-7987
Practice Address - Street 1:55 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4516
Practice Address - Country:US
Practice Address - Phone:212-864-4128
Practice Address - Fax:212-864-7987
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27686101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132759323Medicaid