Provider Demographics
NPI:1346508264
Name:TAKAGI, LUCIENE (LUCY) SANT'ANNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LUCIENE (LUCY)
Middle Name:SANT'ANNA
Last Name:TAKAGI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 POMPTON AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1256
Mailing Address - Country:US
Mailing Address - Phone:973-239-0852
Mailing Address - Fax:973-239-2597
Practice Address - Street 1:882 POMPTON AVE STE A1
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1256
Practice Address - Country:US
Practice Address - Phone:973-239-0852
Practice Address - Fax:973-239-2597
Is Sole Proprietor?:No
Enumeration Date:2012-04-28
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4936103TC0700X
NY19014-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical