Individual
TONI LUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9131 QUEENS BLVD STE 222, ELMHURST, NY 11373-5511
(718) 896-3400
Mailing address
9121 196TH ST, HOLLIS, NY 11423-2648
(718) 849-9654
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
22646
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00244019
—
NY
Enumeration date
12/02/2016
Last updated
12/02/2016
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