Provider Demographics
NPI:1417174277
Name:LUKIN, BERNICE ANN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:BERNICE
Middle Name:ANN
Last Name:LUKIN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TRAPPER LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-5230
Mailing Address - Country:US
Mailing Address - Phone:516-622-6312
Mailing Address - Fax:
Practice Address - Street 1:1 TRAPPER LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-5230
Practice Address - Country:US
Practice Address - Phone:516-622-6312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028533-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP8429083OtherOXFORD
NY7481776OtherGHI
NYP8429083OtherOXFORD