Provider Demographics
NPI:1649247230
Name:LUCKOM NURNBERG, FRAN SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:FRAN
Middle Name:SUE
Last Name:LUCKOM NURNBERG
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 1:444 E 82ND ST
Mailing Address - Street 2:APT 12V
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-5903
Mailing Address - Country:US
Mailing Address - Phone:212-734-1926
Mailing Address - Fax:212-535-6219
Practice Address - Street 1:444 E 82ND ST
Practice Address - Street 2:APT 12V
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-5903
Practice Address - Country:US
Practice Address - Phone:212-734-1926
Practice Address - Fax:212-535-6219
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS7348103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01867101Medicaid
96690OtherCIGNA
7330723OtherGHI
0007096051OtherAETNA
V18711Medicare ID - Type Unspecified