Provider Demographics
NPI:1386361327
Name:PROFACA, LUCIANA CHRISTINA (PHD)
Entity type:Individual
Prefix:DR
First Name:LUCIANA
Middle Name:CHRISTINA
Last Name:PROFACA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 COTTON ST
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-5502
Mailing Address - Country:US
Mailing Address - Phone:650-630-5592
Mailing Address - Fax:
Practice Address - Street 1:1150 COTTON ST
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-5502
Practice Address - Country:US
Practice Address - Phone:650-630-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC443101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional