Provider Demographics
NPI:1457429334
Name:LUKENS, JEAN L (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:LUKENS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N LEVERETT RD
Mailing Address - Street 2:
Mailing Address - City:LEVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:01054-9735
Mailing Address - Country:US
Mailing Address - Phone:413-695-3242
Mailing Address - Fax:413-253-9000
Practice Address - Street 1:664 MAIN ST
Practice Address - Street 2:SUITE #56
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2439
Practice Address - Country:US
Practice Address - Phone:413-695-3242
Practice Address - Fax:413-253-9000
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA160478OtherHARVARD PILGRIM
MA1853864Medicaid
MA460355OtherTUFTS
MA105226OtherLICSW LICENSE
MAP04156OtherBLUE CROSS SHIELD OF MA
MA11353OtherUNITED BEHAVIORAL HEALTH
MA32398OtherHEALTH NEW ENGLAND
MA556232OtherMAGELLAN
MA11353OtherUNITED BEHAVIORAL HEALTH