Provider Demographics
NPI:1144681347
Name:FINE, LUCY (LMFT)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:FINE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:ELLEN
Other - Last Name:FINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:5845 COLLEGE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1635
Mailing Address - Country:US
Mailing Address - Phone:415-987-7261
Mailing Address - Fax:
Practice Address - Street 1:1197 VALENCIA ST STE 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3026
Practice Address - Country:US
Practice Address - Phone:415-987-7261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25468106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist