Provider Demographics
NPI:1699807172
Name:LUKENS, DEBRA L (PHD, LCSW, ACSW)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
Last Name:LUKENS
Suffix:
Gender:F
Credentials:PHD, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MCCUTCHEON DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-3429
Mailing Address - Country:US
Mailing Address - Phone:765-543-7808
Mailing Address - Fax:
Practice Address - Street 1:115 MCCUTCHEON DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-3429
Practice Address - Country:US
Practice Address - Phone:765-543-7808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN914493103TS0200X
IN34001429A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN914493OtherLIC. SCHOOL PSYCHOLOGIST
IN34001429AOtherLIC. CLIN SOCIAL WORKER