Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 3831 | NM |
Y | 1041C0700X | Clinical Social Worker | 2081 | NM |
NPI | 1013002302 |
---|---|
Provider Name | Mr. Frank P Lukasavage |
First Address | Moriarty, NM 87035-3566 |
Second Address | Rio Rancho, NM 87144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 19/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100343 | (05) | NM |
201012186 | PRESBYTERIAN BEHAVIORAL H (01) | NM |