Provider Demographics
NPI:1932406337
Name:LUNA, GARY AARON (LISW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:AARON
Last Name:LUNA
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3495
Mailing Address - Country:US
Mailing Address - Phone:505-426-2545
Mailing Address - Fax:505-426-2782
Practice Address - Street 1:179 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3495
Practice Address - Country:US
Practice Address - Phone:505-426-2545
Practice Address - Fax:505-426-2782
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-051961041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool