Provider Demographics
NPI:1780825414
Name:SERRAQNO, LUCY
Entity Type:Individual
Prefix:MISS
First Name:LUCY
Middle Name:
Last Name:SERRAQNO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:SERRANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA SOCIOLOGY
Mailing Address - Street 1:26844 ISABELLA PKWY APT 202
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-5245
Mailing Address - Country:US
Mailing Address - Phone:661-472-1936
Mailing Address - Fax:
Practice Address - Street 1:6305 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2346
Practice Address - Country:US
Practice Address - Phone:818-908-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF11111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist