Provider Demographics
NPI:1497170971
Name:LUKIN CENTER FOR PSYCHOTHERAPY AND ADVANCEMENT PC
Entity Type:Organization
Organization Name:LUKIN CENTER FOR PSYCHOTHERAPY AND ADVANCEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-903-1901
Mailing Address - Street 1:48 MONROE PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48 MONROE PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2603
Practice Address - Country:US
Practice Address - Phone:917-903-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35SI00522900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty