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General NPI Number Information
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NPI Number | 1649416322
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Entity Type | Organization
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Legal Business Name | ELAINE LUKENDA, PSY.D. LLC
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Dates
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Enumeration Date | 12/30/2008
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 850 N WOOD AVE
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City | LINDEN
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State | NJ
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Zip | 07036-4038
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Country | US
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Telephone | 732-857-6251
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 BAY HEAD DRIVE
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City | PARLIN
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State | NJ
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Zip | 08859-2421
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Country | US
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Telephone | 732-727-1392
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ELAINE LUKENDA
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Credential | PSY.D.
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Telephone | 732-857-6251
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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 | 4292
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License Number State | NJ
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