Provider Demographics
NPI:1912191933
Name:LUCKEY, BERNADINE CORINNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BERNADINE
Middle Name:CORINNE
Last Name:LUCKEY
Suffix:
Gender:F
Credentials:LCSW
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 410994
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94141-0994
Mailing Address - Country:US
Mailing Address - Phone:510-653-2214
Mailing Address - Fax:510-601-9846
Practice Address - Street 1:6221 GEARY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1887
Practice Address - Country:US
Practice Address - Phone:415-558-8177
Practice Address - Fax:415-558-8258
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 240351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical