| Lucid Lane Providers, P.c. | |
|
3251 Place Du Jardin Optional San Jose CA 95148-9514 | |
| (630) 589-2730 | |
| Not Available |
| Full Name | Lucid Lane Providers, P.c. |
|---|---|
| Speciality | Counselor |
| Location | 3251 Place Du Jardin, San Jose, California |
| Authorized Official Name and Position | Mubeena Siddiqui (DIRECTOR OF RCM AND COMPLIANCE) |
| Authorized Official Contact | 6305892730 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lucid Lane Providers, P.c. 3251 Place Du Jardin San Jose CA 95148-3851 Ph: (630) 589-2730 | Lucid Lane Providers, P.c. 3251 Place Du Jardin Optional San Jose CA 95148-9514 Ph: (630) 589-2730 |
| NPI Number | 1912507021 |
|---|---|
| Provider Enumeration Date | 10/28/2020 |
| Last Update Date | 01/29/2021 |
| Certification Date | 10/28/2020 |
| Medicare PECOS PAC ID | 2163839382 |
|---|---|
| Medicare Enrollment ID | O20210405001773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912507021 | NPI | - | NPPES |
| Provider Name | Jason N Wasche |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376857409 PECOS PAC ID: 6103012117 Enrollment ID: I20101201001266 |
| Provider Name | Yvette A Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720235476 PECOS PAC ID: 1658549829 Enrollment ID: I20150924002604 |
| Provider Name | Adam Trotta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588984751 PECOS PAC ID: 5799938114 Enrollment ID: I20160419001088 |
| Provider Name | Meghan Murphy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316452303 PECOS PAC ID: 4587926183 Enrollment ID: I20180320000265 |
| Provider Name | Amer Raheemullah |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1629484811 PECOS PAC ID: 7911253802 Enrollment ID: I20180706002339 |
| Provider Name | Lisa A Vancil |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629382676 PECOS PAC ID: 4082893607 Enrollment ID: I20200428000068 |
| Provider Name | Jennifer Renae Kljajic |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346645413 PECOS PAC ID: 1456629484 Enrollment ID: I20200508002817 |
| Provider Name | Jennifer A Renzi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275076044 PECOS PAC ID: 4981936572 Enrollment ID: I20200925001557 |
| Provider Name | Jose Galindo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154454320 PECOS PAC ID: 5597177501 Enrollment ID: I20201216001636 |
| Provider Name | Hiroko Furo |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1386087849 PECOS PAC ID: 8022304526 Enrollment ID: I20201228002570 |
| Provider Name | Jennifer Harrison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154755080 PECOS PAC ID: 8820497100 Enrollment ID: I20210519002138 |
| Provider Name | Allison Ray Benavides |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508934662 PECOS PAC ID: 3274933478 Enrollment ID: I20210714003537 |
| Provider Name | Jose A Aguilar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730495060 PECOS PAC ID: 5193069276 Enrollment ID: I20210722001228 |
| Provider Name | Laniece P Clausell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790052389 PECOS PAC ID: 4183029473 Enrollment ID: I20210825001186 |
| Provider Name | Ariana Abid |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1285154807 PECOS PAC ID: 9931468584 Enrollment ID: I20210929001508 |
| Provider Name | Jill M Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649421298 PECOS PAC ID: 4981001286 Enrollment ID: I20210929002932 |
| Provider Name | Irene Ramirez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992250070 PECOS PAC ID: 6305238049 Enrollment ID: I20220110000918 |
| Provider Name | Mellissa Teresa Bonilla |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952559825 PECOS PAC ID: 8325415714 Enrollment ID: I20221027000664 |
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Alum Rock Counseling Center, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 277 Mahoney Dr, San Jose, CA 95127 Phone: 408-240-0070 | |
Abode Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1690 Southwest Expy, San Jose, CA 95126 Phone: 510-270-1150 | |
Pacific Clinics Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4 Wabash Ave, San Jose, CA 95128 Phone: 408-295-1814 | |
Sondermind Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6203 San Ignacio Ave Ste 110, San Jose, CA 95119 Phone: 844-843-7279 | |
Radical Roots Psychotherapy, A Licensed Clinical Social Worker, Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1875 Mac Duee Ct., San Jose, CA 95121 Phone: 609-694-1872 |