Provider Demographics
NPI:1669159273
Name:LUNA, JOHN CHARLES (LMSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHARLES
Last Name:LUNA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SORREL HILL CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4121
Mailing Address - Country:US
Mailing Address - Phone:631-943-1364
Mailing Address - Fax:
Practice Address - Street 1:270 JUNIPER RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3131
Practice Address - Country:US
Practice Address - Phone:631-469-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091738-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker