Provider Demographics
NPI:1720228240
Name:LUCERO, ALICIA (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 LA MARIPOSA PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5350
Mailing Address - Country:US
Mailing Address - Phone:505-554-8337
Mailing Address - Fax:505-797-0102
Practice Address - Street 1:7601 LA MARIPOSA PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5350
Practice Address - Country:US
Practice Address - Phone:505-554-8337
Practice Address - Fax:505-797-0102
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI068011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical