Provider Demographics
NPI:1417177106
Name:HOMER, LUKISHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUKISHA
Middle Name:
Last Name:HOMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17232 133RD AVE APT 11G
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3933
Mailing Address - Country:US
Mailing Address - Phone:718-689-0888
Mailing Address - Fax:718-276-2093
Practice Address - Street 1:17232 133RD AVE APT 11G
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3933
Practice Address - Country:US
Practice Address - Phone:718-949-4812
Practice Address - Fax:718-276-2093
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017062103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical