Provider Demographics
NPI:1558089086
Name:LUCERO, TERESA (LMSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 VISTA DEL PRADO CT
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4884
Mailing Address - Country:US
Mailing Address - Phone:505-690-7523
Mailing Address - Fax:
Practice Address - Street 1:4851 PASEO DEL SOL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3027
Practice Address - Country:US
Practice Address - Phone:505-467-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-01431041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool