Provider Demographics
NPI:1942301346
Name:LUKOMSKI, JENNIFER ADELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ADELE
Last Name:LUKOMSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CROSSKEYS OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3508
Mailing Address - Country:US
Mailing Address - Phone:585-223-5920
Mailing Address - Fax:585-223-5727
Practice Address - Street 1:620 CROSSKEYS OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3508
Practice Address - Country:US
Practice Address - Phone:585-223-5920
Practice Address - Fax:585-223-5727
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYO13343103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010013343OtherBLUE CHOICE
NYP020013343OtherBLUE CROSS BLUE SHIELD
NY7202631Medicaid
NY112174FCOtherPREFERRED CARE
NY112174FCOtherPREFERRED CARE