Provider Demographics
NPI:1447764501
Name:LUCERO, LINNAE (M ED)
Entity Type:Individual
Prefix:
First Name:LINNAE
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11039 CALANDRIAS ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6334
Mailing Address - Country:US
Mailing Address - Phone:505-610-2370
Mailing Address - Fax:
Practice Address - Street 1:2632 PENNSYLVANIA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3613
Practice Address - Country:US
Practice Address - Phone:505-610-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health