Provider Demographics
NPI:1689293417
Name:LUKENS, MADELINE BAY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:BAY
Last Name:LUKENS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-0224
Mailing Address - Country:US
Mailing Address - Phone:631-680-2008
Mailing Address - Fax:
Practice Address - Street 1:5 UPHAM DOWN
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-1455
Practice Address - Country:US
Practice Address - Phone:631-680-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107767-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker