Provider Demographics
NPI:1285757708
Name:MELLEGERS, LUCRECIA G (MFT-INTERN)
Entity type:Individual
Prefix:
First Name:LUCRECIA
Middle Name:G
Last Name:MELLEGERS
Suffix:
Gender:F
Credentials:MFT-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3104
Mailing Address - Country:US
Mailing Address - Phone:415-401-2750
Mailing Address - Fax:415-401-2774
Practice Address - Street 1:2712 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3104
Practice Address - Country:US
Practice Address - Phone:415-401-2750
Practice Address - Fax:415-401-2774
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF51486101YA0400X
CA72235106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
10381OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
10381OtherSFGH INTERNAL USE ONLY