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Organization
LUCID LANE PROVIDERS, P.C.
Active
Organization
LUCID LANE PROVIDERS, P.C.
Active
Other names
Lucid Lane Providers, P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MUBEENA SIDDIQUI MA (DIRECTOR OF RCM AND COMPLIANCE)
(630) 589-2730
Entity
Organization
Contact information
Practice address
3251 PLACE DU JARDIN, OPTIONAL, SAN JOSE, CA 95148-9514
(630) 589-2730
Mailing address
3251 PLACE DU JARDIN, SAN JOSE, CA 95148-3851
(630) 589-2730
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
207R00000X
Internal Medicine Physician
—
—
2083X0100X
Occupational Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
10/28/2020
Last updated
01/29/2021
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