Provider Demographics
NPI:1427077015
Name:LUKASIK-BOZZO, VALERIE J
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:J
Last Name:LUKASIK-BOZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:J
Other - Last Name:LUKASIK-BOZZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:19855 W. OUTER DR
Mailing Address - Street 2:SUITE 201 EAST
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-682-4699
Mailing Address - Fax:313-359-2720
Practice Address - Street 1:19855 W. OUTER DR
Practice Address - Street 2:SUITE 201 EAST
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-682-4699
Practice Address - Fax:313-359-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009523103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist