| Lucid Lane Inc | |
|
221 Main St Los Altos CA 94022-2937 | |
| (800) 604-2461 | |
| Not Available |
| Full Name | Lucid Lane Inc |
|---|---|
| Speciality | Counselor |
| Location | 221 Main St, Los Altos, California |
| Authorized Official Name and Position | Mubeena Siddiqui (DIRECTOR OF RCM AND COMPLIANCE) |
| Authorized Official Contact | 6305892730 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lucid Lane Inc 221 Main St # 148 Los Altos CA 94022-2937 Ph: (800) 604-2461 | Lucid Lane Inc 221 Main St Los Altos CA 94022-2937 Ph: (800) 604-2461 |
| NPI Number | 1477047595 |
|---|---|
| Provider Enumeration Date | 06/21/2018 |
| Last Update Date | 04/17/2020 |
| Certification Date | 04/17/2020 |
| Medicare PECOS PAC ID | 9234569922 |
|---|---|
| Medicare Enrollment ID | O20200421000717 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477047595 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Yvette A Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720235476 PECOS PAC ID: 1658549829 Enrollment ID: I20150924002604 |
| Provider Name | Adam Trotta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588984751 PECOS PAC ID: 5799938114 Enrollment ID: I20160419001088 |
| Provider Name | Meghan Murphy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316452303 PECOS PAC ID: 4587926183 Enrollment ID: I20180320000265 |
| Provider Name | Lisa A Vancil |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629382676 PECOS PAC ID: 4082893607 Enrollment ID: I20200428000068 |
| Provider Name | Jennifer Renae Kljajic |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346645413 PECOS PAC ID: 1456629484 Enrollment ID: I20200508002817 |
| Provider Name | Jennifer A Renzi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275076044 PECOS PAC ID: 4981936572 Enrollment ID: I20200925001557 |
| Provider Name | Stephanie A Adams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790106334 PECOS PAC ID: 4486073210 Enrollment ID: I20200929001017 |
| Provider Name | Jose Galindo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154454320 PECOS PAC ID: 5597177501 Enrollment ID: I20201216001636 |
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