Healthcare Provider Details

I. General information

NPI: 1699080333
Provider Name (Legal Business Name): KITTY LUCKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 MISSION ST FL 2
SAN FRANCISCO CA
94103-2911
US

IV. Provider business mailing address

PO BOX 485
HAYWARD CA
94543-0485
US

V. Phone/Fax

Practice location:
  • Phone: 415-597-8043
  • Fax: 415-597-8004
Mailing address:
  • Phone: 510-432-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: