Healthcare Provider Details

I. General information

NPI: 1265787840
Provider Name (Legal Business Name): Adam Lukeman
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date: Adam Lukeman, LCSW Psychotherapist www.adamlukeman.com contact@adamlukeman.com 347-294-3498 • Work Fax (347) 699-7319 • Work
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 West 96th Street Room 2
New York NY
10025
US

IV. Provider business mailing address

111 Bedford Avenue Apt 6
Brooklyn NY
11211
US

V. Phone/Fax

Practice location:
  • Phone: (347) 699-7319
  • Fax: 347-294-3498
Mailing address:
  • Phone: (347) 699-7319
  • Fax: 347-294-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical
License Number72 084998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: