| Lukin Center For Psychotherapy And Advancement Pc | |
|
20 Wilsey Sq Ridgewood NJ 07450-3793 | |
| (201) 409-0393 | |
| Not Available |
| Full Name | Lukin Center For Psychotherapy And Advancement Pc |
|---|---|
| Speciality | Psychologist |
| Location | 20 Wilsey Sq, Ridgewood, New Jersey |
| Authorized Official Name and Position | Konstantin Lukin (PRESIDENT) |
| Authorized Official Contact | 9179031901 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lukin Center For Psychotherapy And Advancement Pc 20 Wilsey Sq Ridgewood NJ 07450-3793 Ph: (201) 409-0393 | Lukin Center For Psychotherapy And Advancement Pc 20 Wilsey Sq Ridgewood NJ 07450-3793 Ph: (201) 409-0393 |
| NPI Number | 1497170971 |
|---|---|
| Provider Enumeration Date | 02/20/2014 |
| Last Update Date | 02/12/2025 |
| Certification Date | 02/12/2025 |
| Medicare PECOS PAC ID | 4183849052 |
|---|---|
| Medicare Enrollment ID | O20140709000704 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497170971 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 35SI00522900 (New York) | Primary |
| Provider Name | Elissa R. Gross |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063741833 PECOS PAC ID: 7618019308 Enrollment ID: I20100119000181 |
| Provider Name | Konstantin Lukin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457776007 PECOS PAC ID: 5092930966 Enrollment ID: I20140709000731 |
| Provider Name | Andrea Kara Tesher |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093217135 PECOS PAC ID: 4284999269 Enrollment ID: I20180522000856 |
| Provider Name | Brian Amorello |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447773544 PECOS PAC ID: 9335495126 Enrollment ID: I20180710000726 |
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