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General NPI Number Information
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NPI Number | 1609910876
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Entity Type | Individual
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Provider Name | BONNIE D LUCKS PH.D
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 6367 ALVARADO CT STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92120-4915
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Country | US
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Telephone | 619-069-0777
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Fax | 619-563-4559
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Provider Business Mailing Address
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Address Line | PO BOX 191274
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City | SAN DIEGO
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State | CA
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Zip | 92159-1274
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Country | US
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Telephone | 619-500-4658
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Fax | 619-563-4559
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSB 22788
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | PSY 22788
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 22788
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License Number State | CA
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