Provider Demographics
NPI:1093015455
Name:LUCERO, IRMA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:IRMA
Other - Middle Name:
Other - Last Name:VALDEZ, CUEVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1014 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660
Mailing Address - Country:US
Mailing Address - Phone:360-695-1014
Mailing Address - Fax:360-750-1374
Practice Address - Street 1:1014 MAIN STREET
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1408
Practice Address - Country:US
Practice Address - Phone:360-566-4432
Practice Address - Fax:360-695-0628
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60185030101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor