Provider Demographics
NPI:1346816170
Name:LUCERO, JEAN PIERRE (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:PIERRE
Last Name:LUCERO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-3518
Mailing Address - Country:US
Mailing Address - Phone:631-874-0185
Mailing Address - Fax:631-909-4796
Practice Address - Street 1:408 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3518
Practice Address - Country:US
Practice Address - Phone:631-874-0185
Practice Address - Fax:631-909-4796
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112141-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty