Provider Demographics
NPI:1306984422
Name:LUGO, RICHARD R (EDD, ICADC, CADCII)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:LUGO
Suffix:
Gender:M
Credentials:EDD, ICADC, CADCII
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:R
Other - Last Name:LUGO ZAVALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD, ICADC, CADCII
Mailing Address - Street 1:140 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2547
Mailing Address - Country:US
Mailing Address - Phone:415-828-4787
Mailing Address - Fax:
Practice Address - Street 1:140 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112
Practice Address - Country:US
Practice Address - Phone:415-828-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 103TC1900X
CAIMF 46835106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling