Provider Demographics
NPI:1083375091
Name:LUCERO, JESSICA MONIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MONIQUE
Last Name:LUCERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:NM
Mailing Address - Zip Code:87732-0209
Mailing Address - Country:US
Mailing Address - Phone:575-387-5069
Mailing Address - Fax:575-387-9006
Practice Address - Street 1:3 MORA VALLEY CLINIC RD
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732-2202
Practice Address - Country:US
Practice Address - Phone:575-387-5069
Practice Address - Fax:575-387-9006
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC119441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical