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General NPI Number Information
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NPI Number | 1497170971
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Entity Type | Organization
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Legal Business Name | LUKIN CENTER FOR PSYCHOTHERAPY AND ADVANCEMENT PC
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 20 WILSEY SQ
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3793
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Country | US
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Telephone | 201-409-0393
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Fax |
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Provider Business Mailing Address
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Address Line | 20 WILSEY SQ
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3793
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Country | US
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Telephone | 201-409-0393
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KONSTANTIN LUKIN
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Credential |
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Telephone | 917-903-1901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00522900
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License Number State | NY
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