Provider Demographics
NPI:1851986780
Name:LUCERO, JERRICA (RBT)
Entity Type:Individual
Prefix:
First Name:JERRICA
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8336 MONROE RD RM 120
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9340
Mailing Address - Country:US
Mailing Address - Phone:734-807-0162
Mailing Address - Fax:888-700-7159
Practice Address - Street 1:8336 MONROE RD RM 120
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9340
Practice Address - Country:US
Practice Address - Phone:734-807-0162
Practice Address - Fax:888-700-7159
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-21-158305106S00000X
MI6451023608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician