Provider Demographics
NPI:1275666745
Name:LUCERO, WENDY RAYLENE (MFT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:RAYLENE
Last Name:LUCERO
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Gender:F
Credentials:MFT
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Mailing Address - Street 1:WENDY LUCERO LMFT
Mailing Address - Street 2:2340 WARD STREET, SUITE 105
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705
Mailing Address - Country:US
Mailing Address - Phone:510-843-6587
Mailing Address - Fax:925-300-3270
Practice Address - Street 1:WENDY LUCERO LMFT
Practice Address - Street 2:2340 WARD STREET, SUITE 105
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-843-6587
Practice Address - Fax:925-300-3270
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2018-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAMFC31454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC31454OtherSTATE LICENSE