Provider Demographics
NPI:1740460641
Name:PONSOR-LUTSKO, SONA JEAN (MFT)
Entity type:Individual
Prefix:MRS
First Name:SONA
Middle Name:JEAN
Last Name:PONSOR-LUTSKO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 OAK VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-5338
Mailing Address - Country:US
Mailing Address - Phone:858-761-8602
Mailing Address - Fax:760-690-2012
Practice Address - Street 1:267 OAK VALLEY LN
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-5338
Practice Address - Country:US
Practice Address - Phone:858-761-8602
Practice Address - Fax:760-690-2012
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11226OtherUNITED BEHAVIORAL HEALTH