Provider Demographics
NPI:1962492868
Name:LUCERO, MICHELE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-0176
Mailing Address - Country:US
Mailing Address - Phone:516-510-6285
Mailing Address - Fax:516-546-1028
Practice Address - Street 1:2277 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3148
Practice Address - Country:US
Practice Address - Phone:516-546-6924
Practice Address - Fax:516-546-1028
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015800-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist