NPIMap

Organization Active NPI

Lucks Psychology, Inc

  • Group Psychotherapy Psychologist
  • San Diego, CA
National Provider Identifier
1841421328
Registry record updated Jul 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Group Psychotherapy PsychologistTaxonomy code 103TP2701X
License
PSY22788 Issued in CA
Legal business name
LUCKS PSYCHOLOGY, INC
Practice address
6367 Alvarado CT Ste 200
San Diego, CA 92120-4915
Phone
(619) 569-0777
Fax
(619) 563-4559
NPI assigned
Aug 3, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bonnie Doreen Lucks, PH.DNPI 1609910876
Title
Clinical Psychologist
Phone
(619) 569-0777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X PSY22788 CA
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PSY22788 CA
Group Psychotherapy PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP2701X PSY22788 CA Primary

Addresses

Primary practice location

6367 Alvarado CT Ste 200
San Diego, CA 92120-4915

Mailing address

PO Box 191274
San Diego, CA 92159-1274
Phone (619) 569-0777

Other names 1

  • Bonnie Lucks, Ph.D Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090821000470 CA Part B Supplier - Clinic/Group Practice 9032263272 Receives reassigned benefits from 2 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Locations

3737 Camino del Rio S
Ste 205
San Diego, CA 92108
Phone (619) 318-9818

2878 Camino del Rio S
Ste 315
San Diego, CA 92108
Phone (619) 340-0417

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659052800000",
    "number": "1841421328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191274",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921591274",
            "telephone_number": "619-569-0777",
            "fax_number": "619-644-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6367 ALVARADO CT STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921204915",
            "telephone_number": "619-569-0777",
            "fax_number": "619-563-4559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCKS PSYCHOLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-03",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "status": "A",
        "authorized_official_last_name": "LUCKS",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "DOREEN",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "619-569-0777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY22788",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY22788",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "CA",
            "license": "PSY22788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bonnie Lucks, Ph.D",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Bonnie Lucks, Ph.D",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.